Provider Demographics
NPI:1609965904
Name:DUPLAN, IRVINE (MD)
Entity Type:Individual
Prefix:
First Name:IRVINE
Middle Name:
Last Name:DUPLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRVINE
Other - Middle Name:
Other - Last Name:DUPLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57066207R00000X
GA057066208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA765124784BMedicaid
GA765124784AMedicaid
GA765124784CMedicaid
GAP00363495OtherRR MEDICARE
GAP00363495OtherRR MEDICARE
GA765124784CMedicaid
GA765124784BMedicaid