Provider Demographics
NPI:1194719088
Name:IVEY, TROY DONOVAN (DO)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:DONOVAN
Last Name:IVEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2929
Mailing Address - Country:US
Mailing Address - Phone:319-352-8033
Mailing Address - Fax:319-352-8034
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-352-8033
Practice Address - Fax:319-352-8034
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2845208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112821Medicaid
IA16446OtherBLUE CROSS BLUE SHIELD
IA0112821Medicaid
IA16446Medicare ID - Type Unspecified