Healthcare Provider Details

I. General information

NPI: 1942202205
Provider Name (Legal Business Name): IRWIN JOHN ISAACS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

IV. Provider business mailing address

4163 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-4843
  • Fax:
Mailing address:
  • Phone: 505-554-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2000-52
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: