Provider Demographics
NPI:1700903242
Name:IRVIN, WILLIAM JOHNSON JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHNSON
Last Name:IRVIN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:14051 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3201
Mailing Address - Country:US
Mailing Address - Phone:804-893-8717
Mailing Address - Fax:804-594-3131
Practice Address - Street 1:14051 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 2210
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3201
Practice Address - Country:US
Practice Address - Phone:804-893-8717
Practice Address - Fax:804-594-3131
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-00276174400000X, 207RH0003X
VA0101251920207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
NC65981UMedicare UPIN