Provider Demographics
NPI:1952546293
Name:CADAVID, GUSTAVO IVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:IVAN
Last Name:CADAVID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAMC, 2817 RIELLY RD
Mailing Address - Street 2:BOX 85
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:786-489-0165
Mailing Address - Fax:
Practice Address - Street 1:WAMC, 2817 RIELLY RD
Practice Address - Street 2:BOX 85
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:786-489-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 65482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry