Provider Demographics
NPI:1578581351
Name:PITTMAN, GAVIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:T
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:155 RADIO DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2619
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-1519
Practice Address - Street 1:640 JACKSON ST - MC 11503L
Practice Address - Street 2:HEALTHPARTNERS REGIONSL SPECIALTY CLINICS
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-2005
Practice Address - Fax:651-254-1519
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47753207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
135135E949OtherUCARE
HP52033OtherHEALTHPARTNERS
MN660273800Medicaid
969991044105OtherPREFERREDONE
332G2PIOtherBLUECROSSBLUESHIELD
901999OtherMEDICA
MN660273800Medicaid
901999OtherMEDICA