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General NPI Number Information
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NPI Number | 1043207749
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Entity Type | Individual
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Provider Name | JOHN D IRVIN MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 4654 LONG BEACH RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8799
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Country | US
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Telephone | 910-457-9564
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Fax | 910-457-6744
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Provider Business Mailing Address
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Address Line | 6407 GREEN ARBOR LN
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City | WILMINGTON
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State | NC
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Zip | 28409-2137
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Country | US
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Telephone | 910-470-3888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 94-01419
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License Number State | NC
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