Provider Demographics
NPI:1992726525
Name:IRVINE, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:IRVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 LOMA RICA RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8728
Mailing Address - Country:US
Mailing Address - Phone:530-743-1356
Mailing Address - Fax:530-743-1611
Practice Address - Street 1:11271 LOMA RICA RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-8728
Practice Address - Country:US
Practice Address - Phone:530-743-1356
Practice Address - Fax:530-743-1611
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992726525Medicaid
P00776475OtherRAILROAD MEDICARE
P00776475OtherRAILROAD MEDICARE
CA1992726525Medicaid
CJ229ZMedicare PIN