Provider Demographics
NPI:1629172358
Name:IRWIN, THOMAS M JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:IRWIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1151 BARATARIA BLVD STE 3100
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3083
Mailing Address - Country:US
Mailing Address - Phone:504-934-8462
Mailing Address - Fax:504-371-3811
Practice Address - Street 1:1151 BARATARIA BLVD STE 3100
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3083
Practice Address - Country:US
Practice Address - Phone:504-934-8461
Practice Address - Fax:504-371-3811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA010120207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128686Medicaid
LAB64104Medicare UPIN
LA1128686Medicaid