Provider Demographics
NPI:1841269354
Name:IVES, WILLIAM LEROY JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEROY
Last Name:IVES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2738
Mailing Address - Country:US
Mailing Address - Phone:717-721-9717
Mailing Address - Fax:717-721-7683
Practice Address - Street 1:21 N STATE ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2738
Practice Address - Country:US
Practice Address - Phone:717-721-9717
Practice Address - Fax:717-721-7683
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 037467E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE71378Medicare UPIN