Provider Demographics
NPI:1083724504
Name:FINE, GAVIN F (MD)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:F
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8687207L00000X, 207LP3000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014217OtherAMERIGROUP PIN
TX1950594OtherUHC PIN
TX373025OtherPRONET PIN
TX139833100OtherFIRSTCARE PIN
1447220850OtherGRP NPI NUMBER
TX8K3991OtherBCBSTX IND PIN
TX00N47FOtherBCBSTX GRP PIN
TX161650005OtherCSHCN
TX5652676OtherAETNA PIN
TX2234925OtherFIRSTHEATLH PIN
TX124199OtherSUPERIOR PIN
TX5222394OtherCIGNA PIN
TX161650004Medicaid
TX124199OtherSUPERIOR PIN
TX5222394OtherCIGNA PIN