Provider Demographics
NPI:1811006760
Name:IRWIN, AMY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
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 1:3409 ELM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2754
Mailing Address - Country:US
Mailing Address - Phone:479-927-2100
Mailing Address - Fax:479-927-2211
Practice Address - Street 1:3409 ELM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2754
Practice Address - Country:US
Practice Address - Phone:479-927-2100
Practice Address - Fax:479-927-2211
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4924207RG0300X
VA0101234673207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005167M84Medicare ID - Type Unspecified
VAI12127Medicare UPIN