Individual
WILLIAM M IRVIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11477 OLDE CABIN RD STE 210, SAINT LOUIS, MO 63141-7129
(314) 997-5208
(314) 997-5368
Mailing address
11477 OLDE CABIN RD STE 210, CREVE COEUR, MO 63141-7129
(314) 997-5208
(314) 997-5368
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
2001010868
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1530953
UNITED HEALTHCARE
—
01
—
158049
BLUE CROSS BLUE SHIELD
—
05
—
205866304
—
MO
01
—
484342
HEALTHLINK
—
01
—
P00049380
RR MEDICARE
—
Enumeration date
09/28/2006
Last updated
12/17/2012
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