Provider Demographics
NPI:1306829049
Name:HALLIDAY, ANDREA LOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LOIS
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 RIVERBEND DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-686-8353
Mailing Address - Fax:541-343-9387
Practice Address - Street 1:3355 RIVERBEND DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-686-8353
Practice Address - Fax:541-343-9387
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25669207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61442Medicare UPIN
131580Medicare ID - Type Unspecified