MEDICARE: GAVIN BLAKE VINCENT PA-C

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	363A00000X	Physician Assistant	0010-16201	NC

General Provider Information

NPI Number	:	1134683394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN BLAKE VINCENT PA-C

Provider Business Mailing Address
First Line	:	710 MILITARY CUTOFF RD STE 320
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-256-4350
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 MILITARY CUTOFF RD STE 320
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-256-4350
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	05/05/2026

Similar Medicare Providers

1972562593 — DR. KAMRAN GOUDARZI M.D.
Practice Location Address:

710 MILITARY CUTOFF RD STE 130
WILMINGTON, NC
28405-2382

Practice Phone: 910-769-3084
Practice Fax: 910-769-6023

1922189844 — MS. CRYSTAL M BRIMER O.D
Practice Location Address:

710 MILITARY CUTOFF ROAD , SUITE 130
WILMINGTON, NC
28405-2382

Practice Phone: 910-447-2020
Practice Fax: 866-984-3914

1548446701 — CRYSTAL VISION, ODPA
Practice Location Address:

710 MILITARY CUTOFF RD STE 130
WILMINGTON, NC
28405-2382

Practice Phone: 910-447-2020
Practice Fax: 866-984-3914

1730322157 — SARAH COURTNEY HOLT PA-C
Practice Location Address:

710 MILITARY CUTOFF RD STE 320
WILMINGTON, NC
28405-2382

Practice Phone: 919-971-8981
Practice Fax:

1013494400 — KAMRAN GOUDARZI SURGICAL PRACTICE PC
Practice Location Address:

710 MILITARY CUTOFF RD STE 130
WILMINGTON, NC
28405-2382

Practice Phone: 910-769-1079
Practice Fax: 910-769-6023

1881531572 — ALYSSA CONROY
Practice Location Address:

330 MILITARY CUTOFF RD STE A2
WILMINGTON, NC
28405-8303

Practice Phone: 910-599-4169
Practice Fax:

Directions to “ GAVIN BLAKE VINCENT PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.