Provider Demographics
NPI:1982577102
Name:HARBOUR-COZART, GAVIN (CHW)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:HARBOUR-COZART
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:GAVIN
Other - Middle Name:
Other - Last Name:COZART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHW
Mailing Address - Street 1:1195 CITY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3325
Mailing Address - Country:US
Mailing Address - Phone:541-342-5088
Mailing Address - Fax:
Practice Address - Street 1:1195 CITY VIEW ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3325
Practice Address - Country:US
Practice Address - Phone:541-342-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR950-060-0100172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker