Provider Demographics
NPI:1497371843
Name:GAVIN PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:GAVIN PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-269-2200
Mailing Address - Street 1:110 E BROWARD BLVD STE 1700
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3500
Mailing Address - Country:US
Mailing Address - Phone:224-269-2200
Mailing Address - Fax:
Practice Address - Street 1:110 EAST BROWARD BLVD.
Practice Address - Street 2:SUITE 1700
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:224-269-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty