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NPI Code Detail

MEDICARE: MR. DWIGHT L BIRKLEY PA-C

MEDICARE:  MR. DWIGHT L BIRKLEY  PA-C
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
1363A00000XPhysician Assistant001137IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00388037OTHERMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128651OTHERIAWELLMARK BCBS IOWA
210375OTHERMIDLANDS CHOICE

General Provider Information

NPI Number : 1932179017
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DWIGHT L BIRKLEY PA-C
Provider Business Mailing Address
First Line : 2730 PIERCE ST
Second Line : SUITE 204
City : SIOUX CITY
State : IA
Zip : 51104-3796
Country : US
Telephone Number : 712-234-8787
Fax Number : 712-234-8777
Provider Business Practice Location Address
First Line : 2730 PIERCE ST
Second Line : SUITE 204
City : SIOUX CITY
State : IA
Zip : 51104-3796
Country : US
Telephone Number : 712-234-8787
Fax Number : 712-234-8777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 11/16/2007

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Directions to “ MR. DWIGHT L BIRKLEY PA-C” Practice Location

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