Individual
DR. GREGORY KEITH IVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26 S HOSPITAL DR, FULTON, MO 65251-2510
(573) 642-0115
(573) 642-4684
Mailing address
26 S HOSPITAL DR, FULTON, MO 65251-2510
(573) 642-0115
(573) 642-4684
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
R9723
MO
208600000X
Surgery Physician
Primary
R9723
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020004558
RAILROAD MEDICARE
MO
01
—
11090
BLUE CROSS/BLUE SHIELD
MO
01
—
1704001
UNITED HEALTH CARE
MO
05
—
201226313
—
MO
01
—
224840
HEALTHLINK
MO
01
—
33711
GROUP HEALTH PLAN
MO
01
—
431339000
HUMANA
MO
01
—
431339000652510
CHAMPUS
MO
01
—
A11946
MERCY HEALTH PLAN
MO
Enumeration date
08/10/2006
Last updated
01/23/2008
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