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Contact Information

ETHAN IRVIN, PHYSICIAN ASSISTANT
655 7TH ST BLDG 700
ROBINS AFB, GA31098-2227
 Phone: 478-497-7569
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Military Health Care Provider

171000000X
Indicates primary specialty

NPI Profile & details for ETHAN IRVIN · (Male)

NPI Number 1538834619
Status Active
Credentials PHYSICIAN ASSISTANT
Entity Individual
Enumeration date 08/11/2021
Last updated 07/28/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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