Provider Demographics
NPI:1891817870
Name:IRONS, SAMUEL ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALLEN
Last Name:IRONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 FLORENCE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4031
Mailing Address - Country:US
Mailing Address - Phone:562-861-2283
Mailing Address - Fax:562-869-3001
Practice Address - Street 1:8615 FLORENCE AVE STE 107
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4031
Practice Address - Country:US
Practice Address - Phone:562-861-2283
Practice Address - Fax:562-869-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-2914213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29140Medicaid
CA000E29140Medicaid
CAE2914Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CA5541470001Medicare NSC