Individual
AMANDA MICHELLE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1340 WONDER WORLD DR, STE 4301, SAN MARCOS, TX 78666-7598
(512) 353-6400
Mailing address
1340 WONDER WORLD DR, STE 4301, SAN MARCOS, TX 78666-7598
(512) 353-6400
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
N9880
TX
Other
Enumeration date
10/11/2006
Last updated
09/22/2011
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