Provider Demographics
NPI:1184647315
Name:CAVIN, IAN R (DO)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:R
Last Name:CAVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7181 S CAMPUS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-4312
Mailing Address - Country:US
Mailing Address - Phone:801-965-3505
Mailing Address - Fax:
Practice Address - Street 1:4252 S HIGHLAND DR STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2690
Practice Address - Country:US
Practice Address - Phone:801-965-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-8456208600000X
UT6446111-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265638357Medicaid
OHI38349Medicare UPIN
OHCA4166711Medicare ID - Type UnspecifiedSPRINGDALE MEDICARE #
OHCA4166715Medicare ID - Type UnspecifiedDAYTON MEDICARE #
OHCA4166717Medicare ID - Type UnspecifiedFAIRBORN MEDICARE #
OHCA4166716Medicare ID - Type UnspecifiedCOLERAIN MEDICARE #
OHCA4166712Medicare ID - Type UnspecifiedMILFORD MEDICARE #
OHCA4166713Medicare ID - Type UnspecifiedMIDDLETOWN MEDICARE #
UT1265638357Medicaid
P00418756Medicare PIN