Individual
GAVIN R DEFISSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(133) 671-6201
Mailing address
2211 S GRAND BLVD APT 310, SAINT LOUIS, MO 63104-1646
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0
NC
Other
Enumeration date
04/02/2025
Last updated
04/02/2025
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