Provider Demographics
NPI:1568920593
Name:BIRMINGHAM, RICHARD ERVIN II (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERVIN
Last Name:BIRMINGHAM
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86065 SINATRA ST
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3908
Mailing Address - Country:US
Mailing Address - Phone:901-674-1783
Mailing Address - Fax:
Practice Address - Street 1:304 BAGWELL RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2813
Practice Address - Country:US
Practice Address - Phone:901-674-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN3860363A00000X
GA9366363A00000X
FLPA9113895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant