Individual
BERT S IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD60217654
WA
390200000X
Student in an Organized Health Care Education/Training Program
11012590A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0284385
L&I
WA
01
—
11012590A
LICENSE
IN
05
—
1245497825
—
WA
Enumeration date
05/21/2008
Last updated
06/23/2022
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