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Organization
VINCENT M IVERS
Active
Organization
VINCENT M IVERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT M IVERS M.D. (PRESIDENT)
(850) 227-7070
Entity
Organization
Contact information
Practice address
301 20TH ST, PORT ST JOE, FL 32456-3301
(850) 227-7070
(850) 227-1989
Mailing address
8401 TRADEWINDS DR, PORT ST JOE, FL 32456-6157
(850) 478-1312
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME65165
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26155
BCBS OF FLORIDA
FL
05
—
376567900
—
FL
Enumeration date
08/25/2006
Last updated
06/17/2019
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