Provider Demographics
NPI:1659457794
Name:GAVINO, REY S (MD)
Entity Type:Individual
Prefix:DR
First Name:REY
Middle Name:S
Last Name:GAVINO
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-0550
Mailing Address - Country:US
Mailing Address - Phone:256-435-5499
Mailing Address - Fax:256-435-6064
Practice Address - Street 1:430 GEORGE WALLACE DR # 246
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-2280
Practice Address - Country:US
Practice Address - Phone:256-343-1800
Practice Address - Fax:256-365-1046
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25404208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933285Medicaid
ALP00190295OtherRR MEDICARE
AL009933285Medicaid