Provider Demographics
NPI:1255330064
Name:IRWIN, TERESA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LYNN
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:LAUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1305 WONDER WORLD DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7546
Mailing Address - Country:US
Mailing Address - Phone:512-396-7575
Mailing Address - Fax:512-396-7555
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-396-7575
Practice Address - Fax:512-396-7555
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3911207V00000X
TXTX-K3911207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0310765-02Medicaid
TX0310765-02Medicaid
TX8921M0Medicare PIN