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Individual
JACOB IVEY
Active
Individual
JACOB IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO4464
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO4464
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO4464
FL
213ES0131X
Foot Surgery Podiatrist
PO4464
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16150857
CAQH
—
01
—
YC4QH
BCBS FL BLUE
FL
Enumeration date
04/03/2021
Last updated
03/10/2025
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