Provider Demographics
NPI:1528255478
Name:GAVIN, JULIUS T JR (MD)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:T
Last Name:GAVIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1582
Mailing Address - Country:US
Mailing Address - Phone:970-949-6849
Mailing Address - Fax:970-949-6849
Practice Address - Street 1:50 SCOTTHILL RD.
Practice Address - Street 2:UB 408
Practice Address - City:BEAVER CREEK
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-949-6849
Practice Address - Fax:970-949-6849
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42263261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74527Medicare UPIN