Doctor Name: | DR. VINCENT M IVERS |
NPI Number: | 1851366702 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | ME0065165 |
Business Practice Address: | 8401 Tradewinds Dr Port St Joe, FL - 32456 |
Business Phone Number: | 8502277070 |
Business Fax Number: | 8502271989 |
Mailing Address: | 301 2oth St, PORT ST JOE |
State: | FL |
Postal Code: | 32456 |
Phone Number: | 8502277070 |
Fax Number: | 8502271989 |
NPI Enumeration Date: | 02/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME0065165 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |