Provider Demographics
NPI:1174508675
Name:SCHWAB, IVAN ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:ROY
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6070
Mailing Address - Fax:916-734-6992
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6070
Practice Address - Fax:916-734-6992
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002104IMedicaid
CAZZZP3420ZMedicare ID - Type Unspecified
CAGR002104IMedicaid