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General NPI Number Information
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NPI Number | 1821109455
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Entity Type | Individual
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Provider Name | DAVID IRVINE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 700 SE 5TH TER STE 7
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4876
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Country | US
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Telephone | 352-563-1720
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Fax | 352-563-0268
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Provider Business Mailing Address
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Address Line | 700 SE 5TH TER STE 7
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4876
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Country | US
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Telephone | 352-563-1720
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Fax | 352-563-0268
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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 | ME92606
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License Number State | FL
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