Provider Demographics
NPI:1497887079
Name:GAUVIN, LLOYD DALE (DO)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:DALE
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 LAFITTE CRES
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3294
Mailing Address - Country:US
Mailing Address - Phone:850-585-4785
Mailing Address - Fax:
Practice Address - Street 1:1234 AIRPORT RD
Practice Address - Street 2:SUITE 12
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2948
Practice Address - Country:US
Practice Address - Phone:850-837-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOS2115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine