MEDICARE: GERALD IRWIN

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	207RG0100X	Gastroenterology Physician	765443	AZ

General Provider Information

NPI Number	:	1184561458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD IRWIN

Provider Business Mailing Address
First Line	:	4150 N 108TH AVE STE 142
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 N 108TH AVE STE 142
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5467
Country	:	US
Telephone Number	:	651-318-2025
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ GERALD IRWIN ” Practice Location

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