Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2003026494 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 04032538 | KS |
NPI | 1225080682 |
---|---|
Provider Name | James Theodore Birch JR. |
First Address | Kansas City, MO 64141-1851 |
Second Address | Kansas City, KS 66160-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010196264 | (05) | VA |
201906013 | (05) | MO |
B05052 | (02) | |
P00284544 | RR MEDICARE (01) | MO |