Provider Demographics
NPI:1336112416
Name:GAVIN, JOHN ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:GAVIN
Suffix:JR
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 1:15 MOSS CREEK VILLAGE
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1105
Mailing Address - Country:US
Mailing Address - Phone:843-681-5077
Mailing Address - Fax:843-681-5012
Practice Address - Street 1:15 MOSS CREEK VILLAGE
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1105
Practice Address - Country:US
Practice Address - Phone:843-681-5077
Practice Address - Fax:843-681-5012
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC26650207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC266508Medicaid
SCG62311Medicare UPIN
SC266508Medicaid