Provider Demographics
NPI:1619852456
Name:CAVINESS, ZACKARY G
Entity type:Individual
Prefix:
First Name:ZACKARY
Middle Name:G
Last Name:CAVINESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SADLER DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7793
Mailing Address - Country:US
Mailing Address - Phone:346-225-3053
Mailing Address - Fax:
Practice Address - Street 1:1350 SADLER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7793
Practice Address - Country:US
Practice Address - Phone:346-225-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5144612146L00000X
TX775403207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic