Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 08362 | MS |
NPI | 1174640643 |
---|---|
Provider Name | Dr. Robert Bryson Irwin |
First Address | Tupelo, MS 38802-0169 |
Second Address | Tupelo, MS 38801-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C48090 | (02) | MS |