Provider Demographics
NPI:1700944923
Name:KERRY D IRONS MD PA
Entity Type:Organization
Organization Name:KERRY D IRONS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-776-0418
Mailing Address - Street 1:701 W LOOP 340 A
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-776-0418
Mailing Address - Fax:254-741-9638
Practice Address - Street 1:701 W LOOP 340 A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-776-0418
Practice Address - Fax:254-741-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE37122083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B23706Medicare UPIN