Provider Demographics
NPI:1730176702
Name:MCEVOY, KEVIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MCEVOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:847 NE19TH
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:SUITE 535
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-274-4999
Practice Address - Fax:503-796-9884
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2015-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD21759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139483Medicaid
WA8239998Medicaid
A018OtherTRICARE
930766376OtherCARE OREGON
G07979OtherPROVIDENCE HEALTH
OR11317OtherHEALTH NET
003395015OtherBLUE CROSS
WA130442OtherDEPT OF LABOR
340016102OtherMEDICARE RAILROAD
A018OtherTRICARE
ORP01484831Medicare PIN
930766376OtherCARE OREGON
WA8239998Medicaid