Healthcare Provider Details

I. General information

NPI: 1790844348
Provider Name (Legal Business Name): JOSE M BIRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. TORRE DE AUXILIO MUTUO SUITE 711 AVE. PONCE DE LEON # 735
SAN JUAN PR
00917-5030
US

IV. Provider business mailing address

COND. TORRE DE AUXILIO MUTUO SUITE 711 AVE. PONCE DE LEON # 735
SAN JUAN PR
00917-5030
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-2563
  • Fax: 787-274-1886
Mailing address:
  • Phone: 787-765-2563
  • Fax: 787-274-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number9343
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9343
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: