Healthcare Provider Details

I. General information

NPI: 1538166715
Provider Name (Legal Business Name): WES JAMES IRWIN MD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 2ND ST STE 1230
RENO NV
89501-1587
US

IV. Provider business mailing address

710 LASSEN DR
SOUTH LAKE TAHOE CA
96150-4446
US

V. Phone/Fax

Practice location:
  • Phone: 530-545-1175
  • Fax:
Mailing address:
  • Phone: 530-545-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number44785-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA83047
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10912
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: