Provider Demographics
NPI:1508836636
Name:GASSEN, GAVIN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:MARTIN
Last Name:GASSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3004 ORANGE GROVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ST. CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-715-7720
Mailing Address - Fax:340-713-9002
Practice Address - Street 1:3004 ORANGE GROVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ST. CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-715-7720
Practice Address - Fax:340-713-9002
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA021693207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GG851ZMedicare UPIN