Vincent M Ivers
Internal Medicine in Port St Joe, FL. Organization (NPI-2).
NPI number1619085354
StatusActive
Last updated in NPPESJun 17, 2019
Details
- NPI
- 1619085354
- Entity type
- Organization (NPI-2)
- Legal business name
- Vincent M Ivers
- Organization subpart
- No
- Enumeration date
- Aug 25, 2006
- Last updated
- Jun 17, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | ME65165 | FL | Yes |
Practice location
301 20th StPort St Joe, FL 32456-3301
Phone 850-227-7070 · Fax 850-227-1989
Mailing address
8401 Tradewinds DrPort St Joe, FL 32456-6157
Phone 850-478-1312 · Fax 850-474-9060
Authorized official
Vincent M Ivers
President
8502277070
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