Provider Demographics
NPI:1295771855
Name:NEGRON, IVAN L (MD)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:L
Last Name:NEGRON
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 1:4084 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5370
Mailing Address - Country:US
Mailing Address - Phone:352-394-1135
Mailing Address - Fax:
Practice Address - Street 1:846 NE 54TH TERRACE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:FL
Practice Address - Zip Code:33521
Practice Address - Country:US
Practice Address - Phone:352-689-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH55637Medicare UPIN