Provider Demographics
NPI:1972696755
Name:MCIVOR, ANDREW CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CRAIG
Last Name:MCIVOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S GARDEN WAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8173
Mailing Address - Country:US
Mailing Address - Phone:541-345-2205
Mailing Address - Fax:541-345-4480
Practice Address - Street 1:360 S GARDEN WAY
Practice Address - Street 2:SUITE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8173
Practice Address - Country:US
Practice Address - Phone:541-345-2205
Practice Address - Fax:541-345-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD184662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059928Medicaid
F67024Medicare UPIN
OR000WCLBMEMedicare PIN