Healthcare Provider Details

I. General information

NPI: 1689648990
Provider Name (Legal Business Name): ROBERT WILLIAM IRWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE P.O. BOX 016960
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4588
  • Fax: 305-243-4650
Mailing address:
  • Phone: 305-243-4588
  • Fax: 305-243-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME 94516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: