Provider Demographics
NPI:1356362040
Name:IRWIN, JAMES P (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:IRWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1001 S HORSEBARN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8184
Mailing Address - Country:US
Mailing Address - Phone:479-273-7700
Mailing Address - Fax:479-464-7734
Practice Address - Street 1:1001 S HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8184
Practice Address - Country:US
Practice Address - Phone:479-273-7700
Practice Address - Fax:479-464-7734
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6596208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1356362040Medicaid
AR340896YS1PMedicare PIN
AR185708003Medicaid
AR771124001OtherBREAST CARE AR SILOAM SPGS LOCATION
AR771123901OtherBREAST CARE ARK SPG. LOCATION
AR5H778OtherBCBS