Provider Demographics
NPI:1134382518
Name:IVERSON, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:IVERSON
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 1:1155 N SHERMAN ST STE 307
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2295
Mailing Address - Country:US
Mailing Address - Phone:720-916-7297
Mailing Address - Fax:303-630-0682
Practice Address - Street 1:1155 N SHERMAN ST STE 309
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2295
Practice Address - Country:US
Practice Address - Phone:720-916-7297
Practice Address - Fax:303-630-0682
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO327582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327584Medicaid
CO023301OtherKAISER COMMERCIAL NUMBER
CO023301OtherKAISER COMMERCIAL NUMBER