Healthcare Provider Details

I. General information

NPI: 1952606667
Provider Name (Legal Business Name): MR. DAVID IRVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 22ND ST
LUBBOCK TX
79410-1350
US

IV. Provider business mailing address

TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR 3601 4TH STREET, MS 8182
LUBBOCK TX
79430-0001
US

V. Phone/Fax

Practice location:
  • Phone: 806-776-4772
  • Fax:
Mailing address:
  • Phone: 806-743-2981
  • Fax: 806-743-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP119890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: