Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8275 | KY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE 60220460 | WA |
NPI | 1063675767 |
---|---|
Provider Name | Dr. James Douglas Bird |
First Address | Tacoma, WA 98405-1333 |
Second Address | Tacoma, WA 98405-1333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 05/07/2011 |