Provider Demographics
NPI:1750328803
Name:GAVINI, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:GAVINI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1524 W. LACEY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-583-4697
Mailing Address - Fax:559-583-4600
Practice Address - Street 1:1524 W. LACEY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-583-4503
Practice Address - Fax:559-583-4535
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA77882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A0733ZMedicare PIN
G60066Medicare UPIN
CAA0733ZMedicare PIN