Basic Information
| Provider Information | |||||||||
| NPI: | 1699742858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1422 OLD WEISGARBER RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Practice Location | |||||||||
| Address1: | 1422 OLD WEISGARBER RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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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 | 207X00000X | MD25431 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 25431 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100011201 | 01 | TN | TENNCARE | OTHER | 4478561 | 01 | TN | AETNA | OTHER | 360843 | 01 | TN | UNITED HEALTH CARE | OTHER | 200029919 | 01 | TN | RAILROAD MEDICARE | OTHER | TN0117 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 3071387 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 3082715 | 05 | TN | MEDICAID | TN0149 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |