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General NPI Number Information
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NPI Number | 1669055182
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Entity Type | Individual
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Provider Name | ROBERT IVEY
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 620 NORTHWESTERN DR POD 4
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City | STORM LAKE
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State | IA
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Zip | 50588-2935
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Country | US
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Telephone | 712-213-8050
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Fax | 712-213-8015
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Provider Business Mailing Address
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Address Line | 1200 1ST AVE E STE C
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City | SPENCER
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State | IA
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Zip | 51301-4342
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Country | US
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Telephone | 712-262-7511
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Fax | 712-262-3658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 124068
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License Number State | IA
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