Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | MD37069 | TN |
NPI | 1083650105 |
---|---|
Provider Name | Daniel James Gavin |
First Address | Cincinnati, OH 45263-0001 |
Second Address | Oak Ridge, TN 37830-6976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3882314 | (05) | TN |
4123793 | BCBS OF TENNESSEE (01) | TN |
H80943 | (02) | TN |
P00317078 | RAILROAD MEDICARE (01) | TN |