Basic Information
| Provider Information | |||||||||
| NPI: | 1114910965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARVIN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 NEWPORT DR | ||||||||
| Address2: | |||||||||
| City: | INDIALANTIC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217330958 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5270 BABCOCK ST NE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | PALM BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329058630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217225959 | ||||||||
| FaxNumber: | 3217225960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME21725 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.