Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10251 | FL |
NPI | 1013067859 |
---|---|
Provider Name | Dr. Gerald William Bird |
First Address | Cocoa, FL 32922-7991 |
Second Address | Cocoa, FL 32922-7991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |