Healthcare Provider Details

I. General information

NPI: 1114072519
Provider Name (Legal Business Name): ANTONIO MODESTO BIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S PACK SQ SUITE 362
ASHEVILLE NC
28801-3511
US

IV. Provider business mailing address

14 S PACK SQ SUITE 362
ASHEVILLE NC
28801-3511
US

V. Phone/Fax

Practice location:
  • Phone: 828-232-1994
  • Fax: 828-232-9941
Mailing address:
  • Phone: 828-232-1994
  • Fax: 828-232-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number9501494
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: