MEDICARE: DR. KEVIN CLIFFORD CAVANAUGH 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	207YS0123X	Facial Plastic Surgery Physician	39322	CO

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	:	1275539843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN CLIFFORD CAVANAUGH MD

Provider Business Mailing Address
First Line	:	1325 DRY CREEK DR
Second Line	:	SUITE 103
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	720-494-9111
Fax Number	:	720-494-9555

Provider Business Practice Location Address
First Line	:	1325 DRY CREEK DR
Second Line	:	SUITE 103
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	720-494-9111
Fax Number	:	720-494-9555

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/26/2015

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