Provider Demographics
NPI:1609210699
Name:BIRDSONG, ORRY CARLISLE (MD)
Entity Type:Individual
Prefix:
First Name:ORRY
Middle Name:CARLISLE
Last Name:BIRDSONG
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 1:8416 E SHEA BLVD STE C-101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6666
Mailing Address - Country:US
Mailing Address - Phone:480-483-3937
Mailing Address - Fax:480-483-8813
Practice Address - Street 1:8416 E SHEA BLVD STE C-101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6666
Practice Address - Country:US
Practice Address - Phone:480-483-3937
Practice Address - Fax:480-483-8813
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62843207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62843OtherMEDICAL LICENSE