Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 0101-048041 | VA |
Y | 2086S0120X | Pediatric Surgery | 01068359A | IN |
NPI | 1548232879 |
---|---|
Provider Name | Clinton Cavett |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000765121 | ANTHEM (01) | IN |
20093210 | (05) | IN |
6754139 | (05) | VA |
D82453 | (02) | VA |