Healthcare Provider Details

I. General information

NPI: 1346321924
Provider Name (Legal Business Name): WILLIAM JAMES MCIVER II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILL MCIVER II M.D.

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 SANTA CLARA AVE SE
ALBUQUERQUE NM
87106-1531
US

IV. Provider business mailing address

3304 SANTA CLARA AVE SE
ALBUQUERQUE NM
87106-1531
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-0440
  • Fax: 505-256-0440
Mailing address:
  • Phone: 505-256-0440
  • Fax: 505-256-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number72-53
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: