Provider Demographics
NPI:1629071899
Name:MUIR, J GAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:J GAVIN
Middle Name:
Last Name:MUIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1235
Mailing Address - Country:US
Mailing Address - Phone:603-626-9500
Mailing Address - Fax:603-626-0899
Practice Address - Street 1:145 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:603-626-0899
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201968Medicaid
NHG84846Medicare UPIN
NH30201968Medicaid