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General NPI Number Information
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NPI Number | 1194042713
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Entity Type | Individual
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Provider Name | BRIAN C BIRCH MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 2921 S MERIDIAN RD
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City | MERIDIAN
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State | ID
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Zip | 83642-7961
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Country | US
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Telephone | 208-297-7847
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Fax | 208-203-0097
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Provider Business Mailing Address
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Address Line | 1775 W STATE ST # 229
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City | BOISE
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State | ID
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Zip | 83702-3924
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Country | US
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Telephone | 208-297-7847
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Fax | 208-203-0097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M-12019
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License Number State | ID
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