Provider Demographics
NPI:1851355382
Name:DARBY, IRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-6310
Mailing Address - Country:US
Mailing Address - Phone:575-556-1898
Mailing Address - Fax:575-556-5959
Practice Address - Street 1:2530 S TELSHOR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4951
Practice Address - Country:US
Practice Address - Phone:575-556-6400
Practice Address - Fax:575-556-6405
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3110363AS0400X
NMPA2016-0065363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291597900Medicaid
FL291597900Medicaid
E4724ZMedicare ID - Type Unspecified