Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO1984 | FL |
NPI | 1013957166 |
---|---|
Provider Name | Dr. Michael Allen Garvin |
First Address | Port St Lucie, FL 34952-5479 |
Second Address | Port St Lucie, FL 34952-5479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052018700 | (05) | FL |
65120T | (02) | FL |
T37314 | (02) | FL |