Provider Demographics
NPI:1225018518
Name:BIRD, MIRFAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRFAT
Middle Name:
Last Name:BIRD
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 1:426 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4616
Mailing Address - Country:US
Mailing Address - Phone:870-836-6820
Mailing Address - Fax:870-836-6827
Practice Address - Street 1:426 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4616
Practice Address - Country:US
Practice Address - Phone:870-836-6820
Practice Address - Fax:870-836-6827
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0012207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127652001Medicaid
ARG06566Medicare UPIN
AR5J716Medicare ID - Type Unspecified