MEDICARE: DR. IAN R CAVIN DO

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	208600000X	Surgery Physician	34-00-8456	OH
2	208600000X	Surgery Physician	6446111-1204	UT

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

General Provider Information

NPI Number	:	1184647315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN R CAVIN DO

Provider Business Mailing Address
First Line	:	7181 S CAMPUS VIEW DR
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-4312
Country	:	US
Telephone Number	:	801-965-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4252 S HIGHLAND DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2690
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/18/2020

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