Healthcare Provider Details

I. General information

NPI: 1043373533
Provider Name (Legal Business Name): VAL GENE IVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ATHLETICS CENTER OSU SPORTSMEDICINE
STILLWATER OK
74078
US

IV. Provider business mailing address

170 ATHLETICS CENTER OSU SPORTSMEDICINE
STILLWATER OK
74078
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-5430
  • Fax: 405-744-4945
Mailing address:
  • Phone: 405-744-5430
  • Fax: 405-744-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number24746
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number24746
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number17462
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number17462
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: