Provider Demographics
NPI:1548266679
Name:SABRSULA, IRVIN F JR (MD)
Entity type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:F
Last Name:SABRSULA
Suffix:JR
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 1:2900 E 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2623
Mailing Address - Country:US
Mailing Address - Phone:979-776-8440
Mailing Address - Fax:877-601-5854
Practice Address - Street 1:2900 E 29TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2623
Practice Address - Country:US
Practice Address - Phone:979-776-8440
Practice Address - Fax:877-601-5854
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035355903Medicaid
TX035355901Medicaid
TX00PK29Medicare ID - Type Unspecified
TX035355901Medicaid
TX294888YSCWMedicare PIN