Individual
PAUL KENNETH GAVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 S PARK ST, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-3447
Mailing address
700 S PARK ST, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-3447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2328-023
WI
363AM0700X
Medical Physician Assistant
2328-023
WI
363AS0400X
Surgical Physician Assistant
2328-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952308272
—
WI
Enumeration date
07/01/2005
Last updated
11/24/2020
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