Provider Demographics
NPI:1871516336
Name:IRVIN, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:IRVIN
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0106
Mailing Address - Country:US
Mailing Address - Phone:870-269-9800
Mailing Address - Fax:870-269-9614
Practice Address - Street 1:803 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560
Practice Address - Country:US
Practice Address - Phone:870-269-9800
Practice Address - Fax:870-269-9614
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR080188461OtherRAILROAD MEDICARE
AR132376001Medicaid
AR770223301OtherAR BREASTCARE
AR17869000000OtherQUALCHOICE
AR17869000000OtherQUALCHOICE
AR5K580Medicare ID - Type Unspecified