Provider Demographics
NPI:1801976949
Name:IVEY, ROGER L (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:IVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5832395-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2090168OtherUNITED HEALTHCARE
ID807208800Medicaid
UT83765OtherPEHP
UTTPRA11412OtherMOLINA
UT99464OtherHEALTHY U
NV100506712Medicaid
UT58323951200001OtherBCBS
UT902393OtherDESERET MUTUAL
WY121505100Medicaid
UT870545614RGGOtherEDUCATORS MUTUAL
AZ948820Medicaid
UTQM0000075886OtherALTIUS
UT107037811101OtherIHC
UT1502954OtherUMWA
UT99464OtherHEALTHY U
UT055327145Medicare ID - Type Unspecified
ID807208800Medicaid