Provider Demographics
NPI:1538119466
Name:BIRDWELL, MAURICE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:DAVID
Last Name:BIRDWELL
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 1:2727 S 144TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5225
Mailing Address - Country:US
Mailing Address - Phone:402-609-1500
Mailing Address - Fax:
Practice Address - Street 1:2727 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5225
Practice Address - Country:US
Practice Address - Phone:402-609-1500
Practice Address - Fax:402-426-1135
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20015207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930039867OtherRAILROAD MEDICARE
IA0922658Medicaid
002475OtherRAILROAD MEDICARE - GRP
NE47064207113Medicaid
G28827Medicare UPIN
NE47064207113Medicaid
092250Medicare ID - Type UnspecifiedGRP