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NPI Code Detail

MEDICARE: ROY IVY III M.D.

MEDICARE: ROY IVY III M.D.
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
1207L00000XAnesthesiology PhysicianK2347TX

General Provider Information

NPI Number : 1649272600
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY IVY III M.D.
Provider Business Mailing Address
First Line : 3300 OAK LAWN AVENUE
Second Line : STE 200
City : DALLAS
State : TX
Zip : 75219-4265
Country : US
Telephone Number : 214-252-3501
Fax Number :
Provider Business Practice Location Address
First Line : 3300 OAK LAWN AVENUE
Second Line : STE 200
City : DALLAS
State : TX
Zip : 75219-4265
Country : US
Telephone Number : 214-252-3501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 06/08/2009

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