MEDICARE: DR. DAVID PETER GAVIN 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	2084P0800X	Psychiatry Physician	036117672	IL

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	:	1861682866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PETER GAVIN MD

Provider Business Mailing Address
First Line	:	110 E BROWARD BLVD STE 1700
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3500
Country	:	US
Telephone Number	:	224-269-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E BROWARD BLVD STE 1700
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3500
Country	:	US
Telephone Number	:	224-269-2200
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	06/29/2021

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