Provider Demographics
NPI:1043413909
Name:IRWIN, JAMIE C (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:C
Last Name:IRWIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:CHARLENE
Other - Last Name:HEARNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-767-9111
Mailing Address - Fax:501-767-3433
Practice Address - Street 1:225 MCAULEY CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6314
Practice Address - Country:US
Practice Address - Phone:501-321-2546
Practice Address - Fax:501-321-1838
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5512208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168836003Medicaid
AR5H255Medicare PIN