Ivan J Reveron, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60063800 Issued in WA

Practice address

5901 N Lidgerwood St Ste 126
Spokane, WA 99208-1122

Phone

(509) 434-1990

Fax

(509) 340-8986

NPI assigned

Aug 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1750393781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N WASHINGTON ST STE 300",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992010233",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N LIDGERWOOD ST STE 126",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081122",
            "telephone_number": "509-434-1990",
            "fax_number": "509-340-8986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVERON",
        "first_name": "IVAN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60063800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Nicole Reuben
• Kirkland Brent Reuer, DDS
• Paul P. Reum
• Carly Reuter
• Jason M. Reuter, MD
• Revita Rehab North LLC (Revita Rehab North)
• Revive Counseling Spokane, PLLC
• Revive Counseling Spokane, PLLC
• Monica Rey Serantes
• Sonja Rey

• Family Medicine Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.