MEDICARE: DR. JOHN BRUCE IRWIN M.D.

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	207P00000X	Emergency Medicine Physician	009436	TN
2	207P00000X	Emergency Medicine Physician	AI8782523	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	930003973	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0053596	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1215982459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRUCE IRWIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 634706
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E OAK HILL AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4522
Country	:	US
Telephone Number	:	865-545-8000
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/09/2010

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Directions to “ DR. JOHN BRUCE IRWIN M.D.” Practice Location

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