Individual
SAMUEL OLIVER STARKE IRVINE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
454 TAYLOR RD, MONTGOMERY, AL 36117-3563
(334) 613-9000
(334) 532-0056
Mailing address
454 TAYLOR RD, MONTGOMERY, AL 36117-3563
(334) 613-9000
(334) 532-0056
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.189
AL
363AS0400X
Surgical Physician Assistant
PA-189
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009934027
—
AL
05
—
009989985
—
AL
05
—
009989995
—
AL
01
—
051001143
BLUE CROSS - 860 MONT RD
AL
01
—
051001307
BLUE CROSS - 48 MED PARK
AL
01
—
051001308
BLUE CROSS - 2660 10TH AV
AL
Enumeration date
05/28/2006
Last updated
05/23/2024
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