MEDICARE: MARK JEFFERY IRBY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA08327	TX
2	363A00000X	Physician Assistant	PA219358	OR

General Provider Information

NPI Number	:	1174967780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JEFFERY IRBY PA-C

Provider Business Mailing Address
First Line	:	7401 SW WASHO CT STE 100
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST
Second Line	:	STE 1700
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-486-7550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	03/11/2026

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Directions to “ MARK JEFFERY IRBY PA-C” Practice Location

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