Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01057472A | IN |
N | 208600000X | Surgeon | 01057472A | IN |
Y | 2086S0127X | Trauma Surgeon | 01057472A | IN |
NPI | 1194726950 |
---|---|
Provider Name | Raymond A. Cava |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104502717 | (05) | MI |
200428480 | (05) | IN |
2402975 | (05) | OH |
H15483 | (02) | IN |