Provider Demographics
NPI:1730175035
Name:IRVINE, SCOTT A (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:IRVINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11538
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1538
Mailing Address - Country:US
Mailing Address - Phone:254-245-9175
Mailing Address - Fax:254-213-7771
Practice Address - Street 1:3800 S W S YOUNG DR STE 201
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3340
Practice Address - Country:US
Practice Address - Phone:254-245-9175
Practice Address - Fax:254-213-7771
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8741207LP2900X, 207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165738906Medicaid
TXP01265608OtherRR MEDICARE
TXTXB165802OtherMEDICARE PTAN