Provider Demographics
NPI:1538166715
Name:IRWIN, WES JAMES (MD MS)
Entity type:Individual
Prefix:DR
First Name:WES
Middle Name:JAMES
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4446
Mailing Address - Country:US
Mailing Address - Phone:530-545-1175
Mailing Address - Fax:
Practice Address - Street 1:300 E 2ND ST STE 1230
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1587
Practice Address - Country:US
Practice Address - Phone:530-545-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44785-020207L00000X
CAA83047207L00000X
NV10912207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI21047Medicare UPIN