Healthcare Provider Details

I. General information

NPI: 1699779173
Provider Name (Legal Business Name): PAUL R IRRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 PARK CENTRAL CT
NAPLES FL
34109-5923
US

IV. Provider business mailing address

5400 PARK CENTRAL CT SUITE 2
NAPLES FL
34109-6001
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-7000
  • Fax: 239-593-7008
Mailing address:
  • Phone: 239-593-7000
  • Fax: 239-593-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: