Provider Demographics
NPI:1528095502
Name:GARVIN, CLIFFORD DAVID (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DAVID
Last Name:GARVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HWY 91 NORTH
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:903-463-8448
Mailing Address - Fax:903-463-7358
Practice Address - Street 1:1300 HWY 91 NORTH
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-463-8448
Practice Address - Fax:903-463-7358
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098392603Medicaid
TX8A1547Medicare ID - Type Unspecified
TX098392603Medicaid