Healthcare Provider Details

I. General information

NPI: 1477563369
Provider Name (Legal Business Name): FRANKLIN LEE IRWIN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 CENTRAL PARKWAY SUITE 304
JACKSONVILLE FL
32224
US

IV. Provider business mailing address

7855 ARGYLE FOREST BLVD STE 101
JACKSONVILLE FL
32244-5597
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-7755
  • Fax: 904-265-7754
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-619-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA105673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA105673
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC1-0007425
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME115817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: