Provider Demographics
NPI:1356316699
Name:IVES, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:IVES
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:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:ESTER
Mailing Address - State:AK
Mailing Address - Zip Code:99725-0440
Mailing Address - Country:US
Mailing Address - Phone:907-452-8346
Mailing Address - Fax:907-451-8346
Practice Address - Street 1:1405 KELLUM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4189
Practice Address - Country:US
Practice Address - Phone:907-452-8346
Practice Address - Fax:907-451-8346
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD03491Medicaid
AKMD03491Medicaid
BI2428630OtherDEA NUMBER