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General NPI Number Information
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NPI Number | 1174640643
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Entity Type | Individual
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Provider Name | ROBERT BRYSON IRWIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4428 S EASON BLVD STE 1
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City | TUPELO
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State | MS
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Zip | 38801-6506
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Country | US
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Telephone | 662-844-5080
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Fax | 662-680-6958
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Provider Business Mailing Address
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Address Line | PO BOX 169
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City | TUPELO
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State | MS
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Zip | 38802-0169
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Country | US
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Telephone | 662-844-5080
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Fax | 662-680-6958
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 08362
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License Number State | MS
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