Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | BP20018944 | TX |
NPI | 1851592752 |
---|---|
Provider Name | Dr. John Andrew Bird |
First Address | Dallas, TX 75390-9063 |
Second Address | Dallas, TX 75390-9063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203553701 | (05) | TX |
OTH000 | (02) | TX |