MEDICARE: DR. ROBERT D BIRCH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	22-156844-1204	UT

General Provider Information

NPI Number	:	1245220805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D BIRCH DO

Provider Business Mailing Address
First Line	:	PO BOX 413076
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3076
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 CHIPETA WAY
Second Line	:	SUITE 1214
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-0108
Country	:	US
Telephone Number	:	801-585-1575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	12/03/2013

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