Healthcare Provider Details

I. General information

NPI: 1306829049
Provider Name (Legal Business Name): ANDREA LOIS HALLIDAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 RIVERBEND DR SUITE 400
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

3355 RIVERBEND DRIVE SUITE 400
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-8353
  • Fax: 541-343-9387
Mailing address:
  • Phone: 541-686-8353
  • Fax: 541-343-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD25669
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: