Provider Demographics
NPI:1275539843
Name:CAVANAUGH, KEVIN CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CLIFFORD
Last Name:CAVANAUGH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 DRY CREEK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7731
Mailing Address - Country:US
Mailing Address - Phone:720-494-9111
Mailing Address - Fax:720-494-9555
Practice Address - Street 1:1325 DRY CREEK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7731
Practice Address - Country:US
Practice Address - Phone:720-494-9111
Practice Address - Fax:720-494-9555
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2015-10-26
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Provider Licenses
StateLicense IDTaxonomies
CO39322207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94320381Medicaid
CO94320381Medicaid
COH43078Medicare UPIN