Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10050795 | TX |
N | 111NI0900X | Internist | BP10050795 | TX |
N | 207RC0200X | Critical Care Medicine | S5325 | TX |
Y | 207RP1001X | Pulmonary Disease | S5325 | TX |
NPI | 1043621030 |
---|---|
Provider Name | Angela Lauren Birdwell |
First Address | San Antonio, TX 78216-2530 |
Second Address | San Antonio, TX 78216-2517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
582864 | PHYSICIAN IN TRAINING LICENSE (01) | TX |
S5325 | TEXAS MEDICAL BOARD (01) | TX |