Individual
TIMOTHY E IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2801 BAY PARK DR, DEPARTMENT OF SURGERY, OREGON, OH 43616-4920
(419) 690-7653
(419) 697-7726
Mailing address
2801 BAY PARK DR, DEPARTMENT OF SURGERY, OREGON, OH 43616-4920
(419) 690-7653
(419) 697-7726
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN163057
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000287582
ANTHEM
OH
01
—
000000479672
ANTHEM
OH
01
—
04097A
PARAMOUNT
OH
05
—
0768601
—
OH
01
—
341881145-003
MMO
OH
05
—
4510675
—
MI
05
—
5182130
—
MI
01
—
P00459029
RRMC
—
Enumeration date
08/24/2005
Last updated
05/01/2012
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