Individual
DR. JOHN W MCIVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(952) 595-1100
(952) 942-3361
Mailing address
11995 SINGLETREE LN, STE 500, EDEN PRAIRIE, MN 55344-5347
(952) 595-1100
(952) 942-3361
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
093421
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00387279
—
NY
Enumeration date
11/21/2005
Last updated
01/19/2011
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