Healthcare Provider Details

I. General information

NPI: 1417158882
Provider Name (Legal Business Name): DUNCAN CAMPBELL MACIVOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST SUITE MS117
LEXINGTON KY
40536-0298
US

IV. Provider business mailing address

800 ROSE ST SUITE MS117
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5425
  • Fax:
Mailing address:
  • Phone: 859-323-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101039415
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number41765
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: