Individual
DR. JEREMY IRVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-5000
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036105497
IL
207P00000X
Emergency Medicine Physician
34419
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105497002
—
IL
05
—
0569475
—
IL
01
—
12105
BCWELLMARK TP
—
01
—
210869
IHS
—
05
—
2569475
—
IL
01
—
930126594
RR MEDICARE
—
01
—
93230
BCWELLMARK WEST
—
01
—
93231
BCWELLMARK 7TH ST
—
01
—
IA0101
JOHN DEERE
—
01
—
IL0181
JOHN DEERE ILLINOIS
—
Enumeration date
02/13/2006
Last updated
12/20/2022
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