# JERRY N CAVANEAU

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1639142284
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E2550 | AR | Yes |

## Other

- **Enumeration date:** 02/13/2006
- **Last updated:** 05/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0007533273 | AETNA | AR |
| 01 | — | 0904380019 | DMERC | AR |
| 05 | — | 140550001 | — | AR |
| 01 | — | 1876582001 | CIGNA | AR |
| 01 | — | 19427000000 | QUALCHOICE | AR |
| 01 | — | 522838 | HEALTHLINK | AR |
| 01 | — | 5L520 | BCBS | AR |