Individual
MARK R GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 DELAWARE ST SE, MMC 480, MINNEAPOLIS, MN 55455-0341
(612) 624-0123
Mailing address
420 DELAWARE ST SE, MMC 480, MINNEAPOLIS, MN 55455-0341
(612) 624-0123
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46726
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110116100
—
MN
Enumeration date
02/06/2006
Last updated
10/12/2007
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