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General NPI Number Information
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NPI Number | 1396755930
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Entity Type | Individual
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Provider Name | SCOTT B BIRDSALL MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 855 MANKATO AVE
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City | WINONA
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State | MN
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Zip | 55987-4868
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Country | US
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Telephone | 507-454-3680
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Fax | 507-457-4160
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Provider Business Mailing Address
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Address Line | 855 MANKATO AVE
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City | WINONA
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State | MN
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Zip | 55987-4868
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Country | US
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Telephone | 507-454-3680
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Fax | 507-457-4160
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30341
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License Number State | MN
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