Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 9875 | OK |
NPI | 1033187208 |
---|---|
Provider Name | Philip C Bird |
First Address | Norman, OK 73071-6443 |
Second Address | Norman, OK 73071-6443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 14/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100134120A | (05) | OK |
C94690 | (02) |