Provider Demographics
NPI:1427047752
Name:IVERSON, ALAN JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JEFFREY
Last Name:IVERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2104 SARGENT CT
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7621
Mailing Address - Country:US
Mailing Address - Phone:530-792-1734
Mailing Address - Fax:707-423-7441
Practice Address - Street 1:2104 SARGENT CT
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7621
Practice Address - Country:US
Practice Address - Phone:530-792-1734
Practice Address - Fax:707-423-7441
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76656208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology