Provider Demographics
NPI:1902814783
Name:GAUVIN, JEFFREY MARK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-569-7316
Mailing Address - Fax:805-683-3400
Practice Address - Street 1:400 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4353
Practice Address - Country:US
Practice Address - Phone:805-569-7316
Practice Address - Fax:805-569-7317
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA99759208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902814783Medicaid