Individual
JACOB IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
15815 SHADDOCK DR STE 130, WINTER GARDEN, FL 34787-5773
(407) 605-2321
(407) 671-4155
Mailing address
15815 SHADDOCK DR STE 130, WINTER GARDEN, FL 34787-5773
(813) 400-1140
(813) 701-9132
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO4464
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO4464
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO4464
FL
213ES0131X
Foot Surgery Podiatrist
PO4464
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16150857
CAQH
—
01
—
YC4QH
BCBS FL BLUE
FL
Enumeration date
04/03/2021
Last updated
03/10/2025
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