Provider Demographics
NPI:1407867864
Name:CAVELL, RICHARD MCLAVY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MCLAVY
Last Name:CAVELL
Suffix:
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 1:1512 W KIRBY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3822
Mailing Address - Country:US
Mailing Address - Phone:318-626-0287
Mailing Address - Fax:318-330-7648
Practice Address - Street 1:4864 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-330-7650
Practice Address - Fax:318-330-7648
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.013766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1313858Medicaid
LAB88976Medicare UPIN
LA5J502Medicare PIN
LA5J502F600Medicare ID - Type Unspecified