Individual
KELLY J IVESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1415 TULANE AVE, HC 71, NEW ORLEANS, LA 70112-2600
(504) 988-5800
(504) 988-7616
Mailing address
1415 TULANE AVE, HC 71, NEW ORLEANS, LA 70112-2600
(504) 988-5800
(504) 988-7616
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
200101
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1628085
—
LA
Enumeration date
11/22/2005
Last updated
08/14/2007
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