Provider Demographics
NPI:1598721276
Name:MCQUIRTER, IVY G (MD)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:G
Last Name:MCQUIRTER
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 1:3061 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3061 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4311
Practice Address - Country:US
Practice Address - Phone:954-491-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106482207R00000X
TNMD37496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4115950OtherBCBS
TNTN01BGOtherJOHN DEERE
TN3887310Medicaid
TN3887310Medicaid
TNTN01BGOtherJOHN DEERE