Provider Demographics
NPI:1164435566
Name:BIRSCHBACH, JANE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:BIRSCHBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SW SIMPSON AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3599
Mailing Address - Country:US
Mailing Address - Phone:541-389-7741
Mailing Address - Fax:541-278-8376
Practice Address - Street 1:25 NW LOUISIANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3294
Practice Address - Country:US
Practice Address - Phone:541-388-8253
Practice Address - Fax:541-617-0894
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20470207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278325Medicaid
G50086Medicare UPIN
OR278325Medicaid