Individual
OWEN R MCIVOR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7000 BOULDER AVE, HIGHLAND, CA 92346-3348
(909) 862-1191
(909) 796-4158
Mailing address
PO BOX 10069, SAN BERNARDINO, CA 92423-0069
(909) 335-4188
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G67842
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G678420
—
CA
Enumeration date
06/06/2006
Last updated
08/28/2019
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