Gavin, Mark R

Gavin, Mark R is an sole proprietor health care provider with primary practice located at 420 Delaware St Se Mmc 480, Minneapolis MN 55455-0341. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gavin, Mark R can be contacted via phone (612) 624-0123.

Contact Information

Primary practice address
420 Delaware St Se Mmc 480 Minneapolis MN 55455-0341
Phone: (612) 624-0123
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 46726 Minnesota

Profile Details

NPI number 1811969785
LBN Legal business name Gavin, Mark R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 6th, 2006
Last updated Oct 12th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811969785 NPPES
Minnesota MEDICAID 110116100

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