Provider Demographics
NPI:1659386712
Name:IRWIN, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:IRWIN
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 1:275 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4316
Mailing Address - Country:US
Mailing Address - Phone:512-321-7137
Mailing Address - Fax:
Practice Address - Street 1:275 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4316
Practice Address - Country:US
Practice Address - Phone:512-321-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00601597OtherRR PTAN
TX080074790Medicaid
TX125459106Medicaid
TX080182504Medicaid
TX125459103Medicaid
TX125459106Medicaid
TX87J399Medicare PIN
TXP00601597OtherRR PTAN