Provider Demographics
NPI:1144230061
Name:IVEY, NATHAN D (DPM)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:IVEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6831
Mailing Address - Country:US
Mailing Address - Phone:505-880-1000
Mailing Address - Fax:505-880-1002
Practice Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-880-1000
Practice Address - Fax:505-880-1002
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM272213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4583990001OtherDME
NM2109215OtherFIRSTHEALTH
NMPROVB13850OtherMOLINA
NM10002146OtherLOVELACE
NM201036405OtherPRESBITERIAN
NM12226807Medicaid
480034544OtherRAILROAD MCR
NMNM005485OtherBLUES
NM201036405OtherPRESBITERIAN
4583990001OtherDME