George G Gavin, PAC
Individual provider Active NPI Physician Assistant · Umatilla, FL
NPI 1376629980 · NPPES record last updated Jun 29, 2010
Key facts
- NPI
- 1376629980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA3095 (FL)
- Practice address
- 390 S Central Ave
Umatilla, FL 32784-2325 - Phone
- (352) 669-3175
- Fax
- (352) 669-3640
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3095 | FL | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA3095 | FL | Yes |
Addresses
Primary practice location
390 S Central Ave
Umatilla, FL 32784-2325
Mailing address
PO Drawer 2325
Umatilla, FL 32784-2325
Phone (352) 669-3175
Other providers in Umatilla, FL
- Barbara Brown Endsley
- Margaret Englund
- Enhancing Lives Inc.
- Jason A Folds
- Mary A Futch
- Tobi D Granger
- Jessica Ann Grayburn
- Steffany Griswold
- Jason Antoine Harris
- Dixon Alan Hays
All providers in Umatilla, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.