Basic Information
| Provider Information | |||||||||
| NPI: | 1316018146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVERS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43708 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | 43708 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | N01874 | 01 | MA | BLUE CROSS | OTHER | P00772236 | 01 | MA | RAILROAD MEDICARE | OTHER | 043708 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0005333 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 3010147 | 05 | MA | MEDICAID | 4247299 | 01 | MA | AETNA | OTHER | 24199 | 01 | MA | FALLON | OTHER | AA17609 | 01 | MA | HARVARD PILGRIM | OTHER |