Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 33400 | MO |
NPI | 1407950017 |
---|---|
Provider Name | Mr. Paul James Garvin |
First Address | St Louis, MO 63128-2175 |
Second Address | Saint Louis, MO 63128-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 05/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200768109 | (05) | MO |