Healthcare Provider Details

I. General information

NPI: 1922024124
Provider Name (Legal Business Name): CRAIG W. IRWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SOUTHPOINT DR
LEXINGTON KY
40515-6350
US

IV. Provider business mailing address

630 SOUTHPOINT DR
LEXINGTON KY
40515-6350
US

V. Phone/Fax

Practice location:
  • Phone: 859-272-1928
  • Fax: 859-271-9601
Mailing address:
  • Phone: 859-272-1928
  • Fax: 859-271-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36288
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36288
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: