Healthcare Provider Details

I. General information

NPI: 1316069990
Provider Name (Legal Business Name): MATTHEW S IVEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 PARKWAY BLVD
SUGAR LAND TX
77478-3425
US

IV. Provider business mailing address

1602 PARKWAY BLVD
SUGAR LAND TX
77478-3425
US

V. Phone/Fax

Practice location:
  • Phone: 713-979-3343
  • Fax: 855-592-3269
Mailing address:
  • Phone: 713-979-3343
  • Fax: 855-592-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: