Provider Demographics
NPI:1134278468
Name:GAVER, JEFFREY W (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:GAVER
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 872104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-2104
Mailing Address - Country:US
Mailing Address - Phone:480-884-1935
Mailing Address - Fax:480-727-3065
Practice Address - Street 1:451 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5391
Practice Address - Country:US
Practice Address - Phone:480-965-3346
Practice Address - Fax:480-965-6531
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31543207P00000X, 207R00000X
WI29355207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31431500Medicaid
AZ976951Medicaid