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General NPI Number Information
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NPI Number | 1316739501
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Entity Type | Individual
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Provider Name | BRYCE ANTHONY IRWIN PA
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Gender | Male
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 234 HOSPITAL DR
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City | UKIAH
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State | CA
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Zip | 95482-4560
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Country | US
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Telephone | 707-463-7356
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Fax | 707-462-4409
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Provider Business Mailing Address
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Address Line | 268 N 2650 W
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City | LEHI
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State | UT
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Zip | 84043-4319
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 67064
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License Number State | CA
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