Provider Demographics
NPI:1528004587
Name:GAVIN, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:GAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:6405 FRANCE AVE S
Practice Address - Street 2:SUITE W440
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2163
Practice Address - Country:US
Practice Address - Phone:952-927-7004
Practice Address - Fax:952-927-5146
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47505208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00217949OtherMEDICARE RAILROAD
MN47505OtherMN LICENSE
MNHP50655OtherHEALTHPARTNERS
MN2341371OtherAMERICA'S PPO
MN766110000Medicaid
MN961901043279OtherPREFERREDONE
MN993N5GAOtherBLUECROSS/BLUESHIELD MN
MN3700049OtherMEDICA
MN181292OtherUCARE MINNESOTA
MN181292OtherUCARE MINNESOTA
MN2341371OtherAMERICA'S PPO
MN3700049OtherMEDICA