Provider Demographics
NPI:1255317285
Name:HAREWOOD, GAVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:C
Last Name:HAREWOOD
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:CLEVELAND CLINIC INDIAN RIVER HOSPITAL
Mailing Address - Street 2:3450 11TH CT STE 206
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-299-3511
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC INDIAN RIVER HOSPITAL
Practice Address - Street 2:3450 11TH CT STE 206
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:722-299-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41632207RG0100X
FLME163485207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN816597100Medicaid