Provider Demographics
NPI:1073614665
Name:MCAVOY, JOHN GALEN (PA MID LEVEL PRACTIT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GALEN
Last Name:MCAVOY
Suffix:
Gender:M
Credentials:PA MID LEVEL PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 PLUMAS ST
Mailing Address - Street 2:STE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-671-2020
Mailing Address - Fax:530-671-6797
Practice Address - Street 1:1233 PLUMAS ST
Practice Address - Street 2:STE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-671-2020
Practice Address - Fax:530-671-6797
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0070950Medicaid
CAGR0070950Medicaid
CAGR0070950Medicaid