Provider Demographics
NPI:1730125386
Name:GAUVIN, RANDALL D (P A)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 COURT ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-5924
Mailing Address - Country:US
Mailing Address - Phone:207-778-0799
Mailing Address - Fax:
Practice Address - Street 1:FRANKLIN MEMORIAL HOSPITAL
Practice Address - Street 2:111 FRANKLIN HEALTH COMMONS
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-779-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-354363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical