Healthcare Provider Details

I. General information

NPI: 1194719088
Provider Name (Legal Business Name): TROY DONOVAN IVEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 9TH ST SW
WAVERLY IA
50677-2929
US

IV. Provider business mailing address

312 9TH ST SW
WAVERLY IA
50677-2929
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-8033
  • Fax: 319-352-8034
Mailing address:
  • Phone: 319-352-8033
  • Fax: 319-352-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2845
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: