Provider Demographics
NPI:1801962675
Name:EXTEIN, IRL L (MD)
Entity type:Individual
Prefix:DR
First Name:IRL
Middle Name:L
Last Name:EXTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16244 MILITARY TRL
Mailing Address - Street 2:325
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-499-6716
Mailing Address - Fax:561-499-6436
Practice Address - Street 1:16244 MILITARY TRL
Practice Address - Street 2:325
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-499-6716
Practice Address - Fax:561-499-6436
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00402662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0040266OtherPIN #
FL40109Medicare ID - Type UnspecifiedIRL L EXTEIN, MD, PA
FLB11009Medicare UPIN
FL79891XMedicare ID - Type UnspecifiedINDIVIDUAL