Provider Demographics
NPI:1942202205
Name:ISAACS, IRWIN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:JOHN
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6742
Mailing Address - Country:US
Mailing Address - Phone:505-554-4843
Mailing Address - Fax:
Practice Address - Street 1:4163 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6742
Practice Address - Country:US
Practice Address - Phone:505-554-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-52207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM374357OtherPRONET / AETNA
AZ515538Medicaid
NM58322Medicaid
NM66352Medicaid
NMNM009R83OtherBLUE CROSS BLUE SHIELD
NM374357OtherPRONET / AETNA
NM66352Medicaid
NM66352Medicaid