Individual
KENNETH JAY IVERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
43 SMITH RD, NAVAL HEALTH CARE NEW ENGLAND NEWPORT, NEWPORT, RI 02841-1002
(860) 694-2377
(860) 694-3590
Mailing address
RTE 12 BLDG 449 ATTN PROFESSIONAL AFFAIRS, NAVAL HEALTH CARE NEW ENGLAND GROTON, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0061931
FL
Other
Enumeration date
05/31/2006
Last updated
07/08/2007
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