Provider Demographics
NPI:1912938887
Name:CAVINESS, DEWAYNE E (MD)
Entity Type:Individual
Prefix:
First Name:DEWAYNE
Middle Name:E
Last Name:CAVINESS
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 1:251 COHASSET RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2235
Mailing Address - Country:US
Mailing Address - Phone:530-345-0064
Mailing Address - Fax:530-345-0080
Practice Address - Street 1:1040 MANGROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3509
Practice Address - Country:US
Practice Address - Phone:530-345-0064
Practice Address - Fax:530-345-0080
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19099208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A190990Medicaid
CA00A190990Medicare ID - Type UnspecifiedMEDICARE
CA00A190990Medicaid