Provider Demographics
NPI:1952363434
Name:PIVAR, NEIL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:DOUGLAS
Last Name:PIVAR
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:PO BOX 21507
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1507
Mailing Address - Country:US
Mailing Address - Phone:505-828-1455
Mailing Address - Fax:
Practice Address - Street 1:6301 WILMINGTON NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6412
Practice Address - Country:US
Practice Address - Phone:505-828-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81288207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19372Medicaid
NM2130691Medicare ID - Type Unspecified
NM19372Medicaid