Individual
ROMAN IVANKIV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
(904) 826-1900
(904) 826-1920
Mailing address
1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
(904) 826-1900
(904) 826-1920
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
338
AL
213ES0131X
Foot Surgery Podiatrist
Primary
PO4215
FL
Other
Enumeration date
09/22/2016
Last updated
03/28/2021
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