Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401007232 | VA |
Y | 213EG0000X | General Practice | 0401007232 | VA |
NPI | 1003801978 |
---|---|
Provider Name | Dr. Eliot William Bird |
First Address | Ashland, VA 23005-7740 |
Second Address | Ashland, VA 23005-7740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |