Provider Demographics
NPI:1184823346
Name:PATRICK R. CAVANAUGH, DO
Entity Type:Organization
Organization Name:PATRICK R. CAVANAUGH, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-776-7300
Mailing Address - Street 1:1350 STUART ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3156
Mailing Address - Country:US
Mailing Address - Phone:303-776-7300
Mailing Address - Fax:303-776-7308
Practice Address - Street 1:1350 STUART ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3156
Practice Address - Country:US
Practice Address - Phone:303-776-7300
Practice Address - Fax:303-776-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01164300Medicaid
COE43484Medicare UPIN