MEDICARE: DR. HENRY ANDREW IRVINE M.D.

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	2083A0100X	Aerospace Medicine Physician	0101235094	VA
2	2085R0202X	Diagnostic Radiology Physician	0101235094	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127605	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780663609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY ANDREW IRVINE M.D.

Provider Business Mailing Address
First Line	:	63245 SILVIS RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9743
Country	:	US
Telephone Number	:	458-206-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	63245 SILVIS RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9743
Country	:	US
Telephone Number	:	458-206-0145
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/19/2026

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