Provider Demographics
NPI:1386681138
Name:IRVINE, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:IRVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 843438
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3438
Mailing Address - Country:US
Mailing Address - Phone:314-567-5850
Mailing Address - Fax:314-567-9169
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 5015-B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-567-5850
Practice Address - Fax:314-567-9169
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO106129207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1386681138OtherHUMANA
MO273406555OtherMULTIPLAN/PHCS
MO209074004Medicaid
MO000000684662OtherANTHEM BCBS
MO273406555OtherTRICARE
MO615723400OtherDEPARTMENT OF LABOR
MO1386681138OtherCOVENTRY/GHP
MO561508OtherHEALTHLINK
MO7308358OtherAETNA
MO561508OtherHEALTHLINK
MO273406555OtherMULTIPLAN/PHCS
MO6470290001Medicare NSC