Provider Demographics
NPI:1881651065
Name:GARVIN, RALPH M (A,T,C)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:M
Last Name:GARVIN
Suffix:
Gender:M
Credentials:A,T,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 KILDEE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8519
Mailing Address - Country:US
Mailing Address - Phone:606-928-4341
Mailing Address - Fax:
Practice Address - Street 1:12307 MIDLAND TRAIL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9639
Practice Address - Country:US
Practice Address - Phone:606-928-7101
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5292255A2300X
KY231-P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic