Individual
DR. DOUGLAS J IVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2507 KENNEDY CIR, BROOKS CITY-BASE, TX 78235-5116
(210) 536-3241
Mailing address
1803 NATIVE DANCER, SAN ANTONIO, TX 78248
(210) 492-5916
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
F8520
TX
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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