Provider Demographics
NPI:1649683640
Name:MCGAVIC, RONALD LYNN JR (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LYNN
Last Name:MCGAVIC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:L
Other - Last Name:MCGAVIC
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40066-1115
Mailing Address - Country:US
Mailing Address - Phone:502-547-7727
Mailing Address - Fax:502-369-9961
Practice Address - Street 1:159 SAINT MATTHEWS AVE STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3137
Practice Address - Country:US
Practice Address - Phone:502-547-7727
Practice Address - Fax:502-369-9961
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY503432084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100362120Medicaid