Provider Demographics
NPI:1144507948
Name:IVERSON,MD, ANDREW PERCY II (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PERCY
Last Name:IVERSON,MD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:PERCY
Other - Last Name:IVERSON, MD
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11 STAPLES POINT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6003
Mailing Address - Country:US
Mailing Address - Phone:207-865-3905
Mailing Address - Fax:
Practice Address - Street 1:11 STAPLES POINT RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6003
Practice Address - Country:US
Practice Address - Phone:207-865-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6119208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology