Healthcare Provider Details

I. General information

NPI: 1285631580
Provider Name (Legal Business Name): DAVID A BIRNBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S HUMBOLDT ST
BATTLE MOUNTAIN NV
89820-1988
US

IV. Provider business mailing address

535 S HUMBOLDT ST
BATTLE MOUNTAIN NV
89820-1988
US

V. Phone/Fax

Practice location:
  • Phone: 775-635-2550
  • Fax: 775-635-2437
Mailing address:
  • Phone: 775-635-2550
  • Fax: 775-635-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number96-16
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96-16
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: