Individual
DR. VINCENT M IVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 20TH ST, PORT ST JOE, FL 32456-3301
(850) 227-7070
(850) 227-1989
Mailing address
8401 TRADEWINDS DR, PORT ST JOE, FL 32456
(850) 478-1312
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME0065165
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376567900
—
FL
Enumeration date
02/22/2006
Last updated
06/17/2019
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