Provider Demographics
NPI:1063630929
Name:MCCARTY, AMANDA WESTFALL (DPM)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:WESTFALL
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:KATE
Other - Last Name:WESTFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1693 SW CHANDLER AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3231
Mailing Address - Country:US
Mailing Address - Phone:541-385-7129
Mailing Address - Fax:541-385-7138
Practice Address - Street 1:1693 SW CHANDLER AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3231
Practice Address - Country:US
Practice Address - Phone:541-385-7129
Practice Address - Fax:541-385-7138
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00439213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026196Medicaid
OR820226002OtherBCBSO
ORR142443Medicare PIN