Basic Information
| Provider Information | |||||||||
| NPI: | 1477563369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRWIN | ||||||||
| FirstName: | FRANKLIN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7855 ARGYLE FOREST BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322445597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9046191080 | ||||||||
| Practice Location | |||||||||
| Address1: | 11555 CENTRAL PARKWAY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042657755 | ||||||||
| FaxNumber: | 9042657754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A105673 | CA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0014X | A105673 | CA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | C1-0007425 | DE | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2081P2900X | ME115817 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000038179 | 05 | DE | MEDICAID | MDCI2358 | 01 | MD | RAILROAD MEDICARE | OTHER | 008912600 | 05 | FL | MEDICAID | DECF8249 | 01 | DE | RAILROAD MEDICARE | OTHER | 409525100 | 05 | CA | MEDICAID |