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NPI Code Detail

MEDICARE: ROBERT D BIRCH DO PC

MEDICARE: ROBERT D BIRCH DO PC
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
12084P0800XPsychiatry Physician221500441204UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932471471
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT D BIRCH DO PC
Provider Business Mailing Address
First Line : 501 CHIPETA WAY
Second Line : SUITE 1214
City : SALT LAKE CITY
State : UT
Zip : 84108-1222
Country : US
Telephone Number : 801-587-3218
Fax Number : 801-547-1929
Provider Business Practice Location Address
First Line : 501 CHIPETA WAY
Second Line : SUITE 1214
City : SALT LAKE CITY
State : UT
Zip : 84108-1222
Country : US
Telephone Number : 801-587-3218
Fax Number : 801-587-3303
Authorized Official
Title or Position : PHYSICIAN
Name : ROBERT D BIRCH
Credential : D.O.
Telephone Number : 801-587-3218
Provider Enumeration Date : 01/30/2012
Last Update Date : 01/30/2012

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