Provider Demographics
NPI:1942252846
Name:IRVING, THOMAS WALTER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WALTER
Last Name:IRVING
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 1:5320 HWY 90 SERVICE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619
Mailing Address - Country:US
Mailing Address - Phone:251-602-1667
Mailing Address - Fax:251-602-5660
Practice Address - Street 1:3401 MEDICAL PARK DR
Practice Address - Street 2:BLDG 1 STE 102
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3318
Practice Address - Country:US
Practice Address - Phone:251-665-8060
Practice Address - Fax:251-665-8061
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8971208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015855OtherMEDICARE
051015855OtherBCBS
051015855OtherBCBS
000015855Medicare ID - Type Unspecified