Provider Demographics
NPI:1457508665
Name:IRVING, JOI C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOI
Middle Name:C
Last Name:IRVING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 LOTUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1704
Mailing Address - Country:US
Mailing Address - Phone:314-367-2570
Mailing Address - Fax:
Practice Address - Street 1:1935 PRAIRIE DELL RD STE 400
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4327
Practice Address - Country:US
Practice Address - Phone:636-583-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine