Provider Demographics
NPI:1740263052
Name:IVESTER, KELLY J (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:IVESTER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:HC 71
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-5800
Mailing Address - Fax:504-988-7616
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC 71
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5800
Practice Address - Fax:504-988-7616
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-08-14
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Provider Licenses
StateLicense IDTaxonomies
LA2001012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628085Medicaid
LA137268Medicare UPIN
LA1628085Medicaid