Provider Demographics
NPI:1194920835
Name:ROY L CAIVANO
Entity type:Organization
Organization Name:ROY L CAIVANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIVANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-447-9900
Mailing Address - Street 1:714 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5711
Mailing Address - Country:US
Mailing Address - Phone:817-447-9900
Mailing Address - Fax:817-447-5010
Practice Address - Street 1:714 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5711
Practice Address - Country:US
Practice Address - Phone:817-447-9900
Practice Address - Fax:817-447-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7923207R00000X
TXM10522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178924001Medicaid
TX178924001Medicaid
TX8F0389Medicare PIN