Individual
DONNA L IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
215 BJ LANE, POOLVILLE, TX 76487
(817) 596-4951
(817) 563-3699
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 563-3699
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G8194
TX
207R00000X
Internal Medicine Physician
G8194
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T90D
BCBS
TX
05
—
139483515
—
TX
01
—
TIN PLUS 005
TRICARE
TX
01
—
TIN PLUS 015
TRICARE
TX
Enumeration date
05/31/2006
Last updated
03/26/2013
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