Provider Demographics
NPI:1336636968
Name:FURTADO, IVAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:LEE
Last Name:FURTADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N FL 789
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N FL 7
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2178
Practice Address - Country:US
Practice Address - Phone:615-284-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2021-09-14
Deactivation Date:2021-07-12
Deactivation Code:
Reactivation Date:2021-09-02
Provider Licenses
StateLicense IDTaxonomies
TN63874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine