Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25289 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | E5044 | AR |
NPI | 1134238793 |
---|---|
Provider Name | Dr. Gordon Troy Birk |
First Address | Hot Springs, AR 71901-7759 |
Second Address | Hot Springs, AR 71901-7759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163783001 | (05) | AR |
G33205 | (02) |