Provider Demographics
NPI:1497787394
Name:GAVIN, ELIZABETH GROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GROSS
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3401 S KELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-6300
Mailing Address - Country:US
Mailing Address - Phone:605-274-0217
Mailing Address - Fax:605-275-6398
Practice Address - Street 1:550 W BURNSVILLE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2504
Practice Address - Country:US
Practice Address - Phone:763-299-8346
Practice Address - Fax:605-275-6398
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN48135208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137135OtherUCARE