MEDICARE: JOSEPH RYAN CAVANER M. ED.

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1699039651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RYAN CAVANER M. ED.

Provider Business Mailing Address
First Line	:	272 NW MEDICAL LOOP
Second Line	:	SUITE E
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5597
Country	:	US
Telephone Number	:	541-440-3532
Fax Number	:	541-440-3554

Provider Business Practice Location Address
First Line	:	272 NW MEDICAL LOOP
Second Line	:	SUITE C
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5597
Country	:	US
Telephone Number	:	541-440-3532
Fax Number	:	541-440-3554

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	05/21/2015

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