Individual
MARTIN J IVERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 S UNION AVE, STE A223, TACOMA, WA 98405-1702
(253) 459-6570
Mailing address
1901 S UNION AVE, STE A223, TACOMA, WA 98405-1702
(253) 459-6570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00041562
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246477
L&I
WA
01
—
5546IV
REGENCE
WA
05
—
8427163
—
WA
01
—
8906215
CVCP
WA
01
—
EX
KPS
WA
Enumeration date
01/08/2006
Last updated
09/19/2013
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