MEDICARE: PROF. RAMILA H GAVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME57056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12880	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1457316671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. RAMILA H GAVAN MD

Provider Business Mailing Address
First Line	:	PO BOX 890
Second Line	:
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-0890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1427
Country	:	US
Telephone Number	:	954-776-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	09/30/2008

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