Provider Demographics
NPI:1730843673
Name:CAVALIER, PAUL ANTHONY (IDHS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:CAVALIER
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCGC ALEX HALEY
Mailing Address - Street 2:C. STREET BLDG 26
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:C. STREET BLDG 26
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99619
Practice Address - Country:US
Practice Address - Phone:907-487-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman