Individual
DOUGLAS PETER IVANCSITS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2330 UTAH AVE STE 200, EL SEGUNDO, CA 90245-4817
(424) 290-8004
Mailing address
5416 TYBEE ISLAND DR, APOLLO BEACH, FL 33572-3307
(813) 928-7954
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME110379
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012100700
—
FL
Enumeration date
03/23/2009
Last updated
06/25/2025
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