MEDICARE: DR. PETER 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	207V00000X	Obstetrics & Gynecology Physician	H7617	TX

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

General Provider Information

NPI Number	:	1790759942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER IRWIN M.D.

Provider Business Mailing Address
First Line	:	6100 HARRIS PKWY
Second Line	:	SUITE 300
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4101
Country	:	US
Telephone Number	:	817-433-5928
Fax Number	:	817-433-5930

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY
Second Line	:	SUITE 300
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4101
Country	:	US
Telephone Number	:	817-433-5928
Fax Number	:	817-433-5930

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/29/2013

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