Provider Demographics
NPI:1225031420
Name:GIRVIN, DAVID CLARK (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARK
Last Name:GIRVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:290 PROGRESS DR
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9099
Practice Address - Country:US
Practice Address - Phone:419-483-4722
Practice Address - Fax:419-483-3483
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34006484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000134862OtherANTHEM BLUE CROSS BLUE SH
OH07852554500OtherBWC IDENTIFIER
OH080115680OtherRAILROAD MEDICARE
G24213Medicare UPIN
OH07852554500OtherBWC IDENTIFIER
GR0811472Medicare ID - Type Unspecified