Provider Demographics
NPI:1780858878
Name:IRVING, ANDREA KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:KAY
Last Name:IRVING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:KAY
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:164 AUGUST LILY CRESCENT
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:ON
Mailing Address - Zip Code:K1V 2E3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19251 E OASIS DR
Practice Address - Street 2:
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324-8878
Practice Address - Country:US
Practice Address - Phone:623-374-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1055207V00000X
AZ005207207VG0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005207OtherAZ STATE LICENSE NUMBER
AZR1055OtherTRAINING PERMIT