Individual
MICHELLE LYNAE IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4085 DE ZAVALA RD STE 200, SHAVANO PARK, TX 78249-2084
(210) 558-6288
(210) 558-6289
Mailing address
PO BOX 681149, SAN ANTONIO, TX 78268-1149
(210) 558-6288
(210) 558-6289
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
53547
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
A115609
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
U8537
TX
Other
Enumeration date
04/14/2009
Last updated
05/30/2024
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