Gavin R Defisser, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Practice address

1 Medical Center Blvd
Winston Salem, NC 27157-0001

Phone

(133) 671-6201

NPI assigned

Apr 2, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1477357366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 S GRAND BLVD APT 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "133-671-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFISSER",
        "first_name": "GAVIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-02",
        "last_updated": "2025-04-02",
        "certification_date": "2025-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leigh-Ervin Stewart Dedmon, MA, CCC-SLP
• Azra Nicolle Dees, MD
• Rita L Defazio, PT
• David Defeo, M.D.
• Defined Home Care LLC
• Anthony John Defranzo Jr., MD
• Hayley Degnan
• Nicholas Robert Degner, MD, MPH
• Jeffrey Samuel Deguire, PT
• Letisha Jolene Deibert, MD

• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.