MEDICARE: DR. THOMAS LEE IRVIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	74251	MN
2	207RR0500X	Rheumatology Physician	G7933	TX
3	207RR0500X	Rheumatology Physician	65461	GA

General Provider Information

NPI Number	:	1083684369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LEE IRVIN MD

Provider Business Mailing Address
First Line	:	546 W FIVE NOTCH RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9363
Country	:	US
Telephone Number	:	803-279-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-5302
Country	:	US
Telephone Number	:	651-254-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	06/20/2023

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