Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 96-16 | NM |
N | 207QS0010X | Family Doctor - Sports Medicine | 96-16 | NM |
NPI | 1285631580 |
---|---|
Provider Name | David A Birnbaum |
First Address | Battle Mountain, NV 89820-1988 |
Second Address | Battle Mountain, NV 89820-1988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29507367 | (05) | NM |
D14482 | (02) | IL |