Provider Demographics
NPI:1043373533
Name:IVEN, VAL GENE (MD)
Entity Type:Individual
Prefix:
First Name:VAL GENE
Middle Name:
Last Name:IVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 ATHLETICS CENTER
Mailing Address - Street 2:OSU SPORTSMEDICINE
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078
Mailing Address - Country:US
Mailing Address - Phone:405-744-5430
Mailing Address - Fax:405-744-4945
Practice Address - Street 1:170 ATHLETICS CENTER
Practice Address - Street 2:OSU SPORTSMEDICINE
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078
Practice Address - Country:US
Practice Address - Phone:405-744-5430
Practice Address - Fax:405-744-4945
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24746207RS0010X, 2081S0010X
OK17462207RS0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13752Medicare UPIN