Healthcare Provider Details

I. General information

NPI: 1346468246
Provider Name (Legal Business Name): DAVID MICHAEL BIRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21202 HARVEST HLS
SAN ANTONIO TX
78258-7404
US

IV. Provider business mailing address

21202 HARVEST HLS
SAN ANTONIO TX
78258-7404
US

V. Phone/Fax

Practice location:
  • Phone: 210-912-8587
  • Fax:
Mailing address:
  • Phone: 210-912-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK3100
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number263074-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: