Provider Demographics
NPI:1174640643
Name:IRWIN, ROBERT BRYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRYSON
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0169
Mailing Address - Country:US
Mailing Address - Phone:662-844-5080
Mailing Address - Fax:662-680-6958
Practice Address - Street 1:4428 S EASON BLVD
Practice Address - Street 2:STE 1
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6506
Practice Address - Country:US
Practice Address - Phone:662-844-5080
Practice Address - Fax:662-680-6958
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08362207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC48090Medicare UPIN