Provider Demographics
NPI:1215948039
Name:IRWIN, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1834 E INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:520-825-9656
Mailing Address - Fax:520-818-2525
Practice Address - Street 1:1834 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-825-9656
Practice Address - Fax:520-818-2525
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7681OtherHEALTHNET ID
AZ110209395OtherMEDICARE RR
AZ86100229485739A002OtherCHAMPUS ID
AZAZ04553OtherMCARE SUB ID
AZ28417OtherSTATE LICENSE #
AZAZ0877220OtherBLUE CROSS ID
AZ861002294OtherDESERT SAGE TAX ID#
AZAZ0877220OtherBLUE CROSS ID
AZ110209395OtherMEDICARE RR