IVAN ALEXIS LICEA TAMAYO (NPI# 1669895223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669895223 |
| Entity Type | Individual |
| Full Name | IVAN ALEXIS LICEA TAMAYO |
| Credential | MD |
| Practice Address |
4371 Narrow Lane Rd Montgomery AL 36116-2971 |
| Practice Telephone | 3346133680 |
| Mailing Telephone | 3346133680 |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | L3510R | AL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | ME 118521 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
4371 NARROW LANE RD |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36116-2971 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265410781 | Glenda Atilano | Internal Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2006-01-04 |
| 1235533407 | Chethana R. Phonde | Family Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2014-10-17 |
| 1770987943 | Jaisingh Rajput | Family Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2014-10-17 |
| 1225432453 | Kashiff M. Muneer | Family Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2014-10-17 |
| 1265836522 | Kiana K Foster | General Practice | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2014-10-15 |
| 1487075289 | James Francis Henderson | Family Medicine | 4371 Narrow Lane Rd, Montgomery, AL 36116-2971 | 2013-12-20 |
| 1528344025 | Bethany Jacobs Meredith | Family Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2011-10-27 |
| 1861777997 | Robin L Koffarnus | Pharmacist | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2011-10-20 |
| 1255613527 | Vikas Gupta | Family Medicine | 4371 Narrow Lane Rd, Suite 100, Montgomery, AL 36116-2971 | 2011-09-13 |
| 1639458987 | Pooja Sethi | Internal Medicine | 4371 Narrow Lane Rd, Montgomery, AL 36116-2971 | 2011-08-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275153892 | Sayyeda Ann Uz Zahra | Student in an Organized Health Care Education/Training Program | 2055 East South Blvd. Suite 202, Uab Montgomery, Montgomery, AL 36116 | 2020-04-23 |
| 1861958241 | Tameka Lene' Myles | Nurse Practitioner | 2905 East South Boulevard, Montgomery, AL 36116 | 2019-02-11 |
| 1750869814 | Nina Yvette Massey | Family Medicine | Baptist South Uab Multi Specialty Clinic, 2119 E. South Blvd, Montgomery, AL 36116 | 2018-08-01 |
| 1336635697 | Briana Lynn Adair | Speech-Language Pathologist | 2185 Normandie Rd., Montgomery, AL 36116 | 2018-07-10 |
| 1790201770 | Rinka Ravi Pahwani | Student in an Organized Health Care Education/Training Program | 4371 Narrow Lane Road, Suite 100, Montgomery, AL 36116 | 2017-08-21 |
| 1982052015 | Kevin J Jones | Pharmacist | 4385 Narrow Lane Rd, Montgomery, AL 36116 | 2016-05-31 |
| 1891153284 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 8035 Vaughn Road, Montgomery, AL 36116 | 2016-02-01 |
| 1871917583 | E Dental | Dentist | 6956 Vaughn Rd, Montgomery, AL 36116 | 2014-02-17 |
| 1033545199 | Jennings Professional Services LLC | Home Health | 2921 Martin Lane, Montgomery, AL 36116 | 2013-09-20 |
| 1750721973 | Joseph Alan Taylor | Counselor | 8104 Seaton Place, Montgomery, AL 36116 | 2013-07-02 |
| Find all providers in zip 36116 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952919490 | Age Well Concierge Medicine | Family Medicine | 18441 Tx-105, Suite B, Montgomery, TX 77356 | 2020-07-21 |
| 1992313670 | Integrated Medical Care Pllc | Family Medicine | 10427 Twin Circles Dr, Montgomery, TX 77356-4704 | 2020-07-17 |
| 1750906921 | Doctors Making Home Visits 1st Inc | Family Medicine | 922 S Perry St, Montgomery, AL 36104-5022 | 2020-06-12 |
| 1508496688 | Montgomery General Hospital, Inc | Family Medicine | 401 6th Ave Ste 301, Montgomery, WV 25136-2116 | 2020-01-17 |
| 1427521962 | Health Services, Inc | Family Medicine | 2801 Willena Ave, Montgomery, AL 36107-1055 | 2019-01-08 |
| 1750869814 | Nina Yvette Massey | Family Medicine | Baptist South Uab Multi Specialty Clinic, 2119 E. South Blvd, Montgomery, AL 36116 | 2018-08-01 |
| 1871010223 | Micah Bosley Md, Pllc | Family Medicine | 102 Piping Rock Dr, Montgomery, TX 77356-5860 | 2017-08-26 |
| 1003267899 | Your Doctor's Office, PC | Family Medicine | 8630 Vaughn Rd, Montgomery, AL 36117-8852 | 2016-06-23 |
| 1194175513 | Miho Suga | Family Medicine | 1801 Pine St Ste 301, Montgomery, AL 36106-1154 | 2016-06-16 |
| 1265834618 | Sarah Elizabeth Connors | Family Medicine | 4150 Carmichael Rd Ste B, Montgomery, AL 36106-2933 | 2014-09-17 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 36116 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.