Provider Demographics
NPI:1124070719
Name:GAVIN, ROY CURTIS (CRNA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:CURTIS
Last Name:GAVIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 BEACH BLVD APT C113
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-5126
Mailing Address - Country:US
Mailing Address - Phone:318-801-5526
Mailing Address - Fax:
Practice Address - Street 1:2046 BEACH BLVD APT C113
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-5126
Practice Address - Country:US
Practice Address - Phone:318-801-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04871367500000X
LARN113738367500000X
MSR863777367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05789291Medicaid
P01334707OtherRAILROAD MEDICARE
MS337055YKFFMedicare PIN