Individual
ETHAN IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
655 7TH ST BLDG 700, ROBINS AFB, GA 31098-2227
(478) 497-7569
Mailing address
2803 MEDICAL CAMPUS DR, GOLDSBORO, NC 27531
(919) 722-1802
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/11/2021
Last updated
07/28/2023
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