Healthcare Provider Details

I. General information

NPI: 1154975001
Provider Name (Legal Business Name): JACOB MCAVOY DMSC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W 7TH AVE STE 655
EUGENE OR
97402-5113
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 458-320-0320
  • Fax:
Mailing address:
  • Phone: 602-248-8886
  • Fax: 602-854-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.70003991
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA195490
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: