Individual
DR. DAVID L IVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 N MAGDALEN ST, SAN ANGELO, TX 76903-5400
(325) 481-2170
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J2617
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118591004
—
TX
01
—
8W2104
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/27/2006
Last updated
01/06/2010
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