Healthcare Provider Details

I. General information

NPI: 1699954172
Provider Name (Legal Business Name): STEPHEN ALEXANDER IRWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 HAWTHORNE ST STE 101
SARASOTA FL
34239-2368
US

IV. Provider business mailing address

9330 LBJ FWY STE 800
DALLAS TX
75243-4310
US

V. Phone/Fax

Practice location:
  • Phone: 941-362-5555
  • Fax: 941-362-5559
Mailing address:
  • Phone: 972-792-5700
  • Fax: 214-506-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME98838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: