Provider Demographics
NPI:1336182971
Name:IRLAND, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:IRLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 W. MAY ST.
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301
Mailing Address - Country:US
Mailing Address - Phone:319-642-5543
Mailing Address - Fax:319-642-8069
Practice Address - Street 1:300 W. MAY ST.
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301
Practice Address - Country:US
Practice Address - Phone:319-642-5543
Practice Address - Fax:319-642-8068
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA32527207Q00000X
NE20992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG60672Medicare UPIN