Provider Demographics
NPI:1972663524
Name:GAVIS, JAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:E
Last Name:GAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:2002 FOULK RD
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3643
Practice Address - Country:US
Practice Address - Phone:302-334-0330
Practice Address - Fax:302-334-0329
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC2-0011612207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE477017Medicare PIN
PA053455Medicare PIN
PAH53068Medicare UPIN