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1134772924

NPI Code Detail

MEDICARE: RICHARD DEAN IVERSON

MEDICARE: RICHARD DEAN IVERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DO61534281	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	OP61534281	WA

General Provider Information

NPI Number	:	1134772924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DEAN IVERSON

Provider Business Mailing Address
First Line	:	200 UNIVERSITY PKWY
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98901-9539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UNIVERSITY PKWY
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98901-9539
Country	:	US
Telephone Number	:	509-452-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2019
Last Update Date	:	06/06/2024

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Directions to “ RICHARD DEAN IVERSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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