Provider Demographics
NPI:1407950017
Name:GARVIN, PAUL JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAMES
Last Name:GARVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:STE 330A
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2175
Mailing Address - Country:US
Mailing Address - Phone:314-543-5963
Mailing Address - Fax:314-525-4323
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:STE 330A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2175
Practice Address - Country:US
Practice Address - Phone:314-543-5963
Practice Address - Fax:314-525-4323
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO33400204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200768109Medicaid
MOA27870Medicare PIN
MO20017141Medicare PIN