Provider Demographics
NPI:1437262094
Name:IRWIN, SANDE BARTELS (MD)
Entity Type:Individual
Prefix:
First Name:SANDE
Middle Name:BARTELS
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDE
Other - Middle Name:
Other - Last Name:BARTELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 SE BELLA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 SE PARK PLAZA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5886
Practice Address - Country:US
Practice Address - Phone:360-449-7032
Practice Address - Fax:360-449-7040
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23613207Y00000X
WAMD00040942207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology