Provider Demographics
NPI:1992903207
Name:MCCAGUE, ANDREW (DO, FACOS, FACS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MCCAGUE
Suffix:
Gender:
Credentials:DO, FACOS, FACS
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:MCCAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4234 RIVERWALK PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3304
Mailing Address - Country:US
Mailing Address - Phone:951-373-5800
Mailing Address - Fax:951-344-8303
Practice Address - Street 1:4234 RIVERWALK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3304
Practice Address - Country:US
Practice Address - Phone:951-373-5800
Practice Address - Fax:951-344-8303
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A109102086S0102X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery