MEDICARE: DR. ALAN JEFFREY IVERSON MD

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	208800000X	Urology Physician	A76656	CA

General Provider Information

NPI Number	:	1427047752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN JEFFREY IVERSON MD

Provider Business Mailing Address
First Line	:	2104 SARGENT CT
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-7621
Country	:	US
Telephone Number	:	530-792-1734
Fax Number	:	707-423-7441

Provider Business Practice Location Address
First Line	:	2104 SARGENT CT
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-7621
Country	:	US
Telephone Number	:	530-792-1734
Fax Number	:	707-423-7441

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	12/22/2021

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