Provider Demographics
NPI:1538115621
Name:IRWIN, DOUGLAS G (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:509 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6195
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-598-0983
Practice Address - Street 1:94 MARIE LANGDON DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6353
Practice Address - Country:US
Practice Address - Phone:606-599-9955
Practice Address - Fax:606-599-9966
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY38637207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081466Medicaid
KYH20353Medicare UPIN
3321180Medicare PIN