Provider Demographics
NPI:1699742858
Name:IVY, ROBERT EUGENE (MD,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:IVY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1293
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:865-558-4471
Practice Address - Street 1:1422 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1293
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4471
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25431207XS0106X
TNMD25431207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100011201OtherTENNCARE
TNTN0117OtherJOHN DEERE HEALTHCARE
TN3071387OtherBLUE CROSS BLUE SHIELD
TN360843OtherUNITED HEALTH CARE
TN200029919OtherRAILROAD MEDICARE
TNTN0149OtherJOHN DEERE HEALTHCARE
TN3082715Medicaid
TN4478561OtherAETNA
F55880Medicare UPIN
TN103I403418Medicare PIN
TN3082717Medicare PIN
TN4478561OtherAETNA
TN3071387OtherBLUE CROSS BLUE SHIELD