Provider Demographics
NPI:1154304624
Name:TURNER, IVETTE C (MD)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:C
Last Name:TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 W CLAY RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1177
Practice Address - Country:US
Practice Address - Phone:573-378-2349
Practice Address - Fax:888-979-8868
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K66207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205370919Medicaid
36292011OtherBCBS
N06D632Medicare PIN
36292011OtherBCBS
MOH36121Medicare UPIN