MEDICARE: DR. REY S GAVINO M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	25404	AL
2	207R00000X	Internal Medicine Physician	25404	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00190295	OTHER	AL	RR MEDICARE

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	:	1659457794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REY S GAVINO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-0550
Country	:	US
Telephone Number	:	256-435-5499
Fax Number	:	256-435-6064

Provider Business Practice Location Address
First Line	:	430 GEORGE WALLACE DR # 246
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35903-2280
Country	:	US
Telephone Number	:	256-343-1800
Fax Number	:	256-365-1046

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/26/2023

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Directions to “ DR. REY S GAVINO M.D.” Practice Location

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