Individual
JOEL B KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1650 CARROL DR, BILOXI, MS 39531-4301
(228) 206-4312
Mailing address
1650 CARROL DR, BILOXI, MS 39531-4301
(228) 206-4312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17254
MS
174400000X
Specialist
—
—
207R00000X
Internal Medicine Physician
Primary
17254
MS
208M00000X
Hospitalist Physician
17254
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0124651
—
MS
05
—
03551501
—
MS
01
—
7927259
AETNA
MS
01
—
MEDICARE RR
110222271
MS
Enumeration date
08/31/2006
Last updated
11/09/2022
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