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General NPI Number Information
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NPI Number | 1407966815
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Entity Type | Organization
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Legal Business Name | MANSFIELD MEDICAL CLINIC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 1720 E BROAD ST
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City | MANSFIELD
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State | TX
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Zip | 76063-3400
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Country | US
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Telephone | 817-453-5912
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Fax | 817-453-2988
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Provider Business Mailing Address
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Address Line | 1720 E BROAD ST
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City | MANSFIELD
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State | TX
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Zip | 76063-3400
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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 | OWNER
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Name | DR. JAMES IRVINE
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Credential | D.O
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Telephone | 817-453-5912
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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 | J3502
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License Number State | TX
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