Individual
DR. WAYNE LAWRENCE IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16 WINCHESTER PLZ, WINCHESTER, KY 40391-1143
(859) 513-0078
(859) 737-5020
Mailing address
PO BOX 4197, WINCHESTER, KY 40392-4197
(859) 513-0078
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
50617
KY
207RC0000X
Cardiovascular Disease Physician
G30486
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0569343
CLIA
KY
01
—
50617
MEDICAL LICENSE
KY
05
—
7100563520
—
KY
01
—
G30486
MEDICAL LINCENSE
CA
Enumeration date
01/31/2007
Last updated
12/30/2020
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