Provider Demographics
NPI:1306827613
Name:BIR, MARK S (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:BIR
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:820 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5445
Practice Address - Country:US
Practice Address - Phone:239-434-0166
Practice Address - Fax:239-424-7553
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA1623363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS50315Medicare UPIN
FLE2387XMedicare PIN