Provider Demographics
NPI:1316391584
Name:GAVIN, JOSHUA (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GAVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-0130
Mailing Address - Country:US
Mailing Address - Phone:970-858-3900
Mailing Address - Fax:970-858-2208
Practice Address - Street 1:576 KOKOPELLI BLVD
Practice Address - Street 2:UNIT D-E
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6304
Practice Address - Country:US
Practice Address - Phone:970-858-2590
Practice Address - Fax:970-858-5036
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205946207R00000X
CODR.0072987207RR0500X
TXBP10056500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine