Provider Demographics
NPI:1467481580
Name:BIRD, EUGENIO F (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:F
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 OUTER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6652
Mailing Address - Country:US
Mailing Address - Phone:407-644-4477
Mailing Address - Fax:407-644-9549
Practice Address - Street 1:895 OUTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6652
Practice Address - Country:US
Practice Address - Phone:407-644-4477
Practice Address - Fax:407-644-9549
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063398400Medicaid
FLB89822Medicare UPIN
FL10258VMedicare PIN