MEDICARE: ROY IVY JR ASSOCIATES

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	207V00000X	Obstetrics & Gynecology Physician	D5045	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457359879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY IVY JR ASSOCIATES

Provider Business Mailing Address
First Line	:	1700 CURIE DR
Second Line	:	SUITE 2000
City	:	EL PASO
State	:	TX
Zip	:	79902-2905
Country	:	US
Telephone Number	:	915-532-4631
Fax Number	:	915-544-9461

Provider Business Practice Location Address
First Line	:	1700 CURIE DR
Second Line	:	SUITE 2000
City	:	EL PASO
State	:	TX
Zip	:	79902-2905
Country	:	US
Telephone Number	:	915-532-4631
Fax Number	:	915-544-9461

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ROY IVY JR.
Credential	:	M.D.
Telephone Number	:	915-532-4631

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	06/16/2008

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