Provider Demographics
NPI:1720004930
Name:BIRD, GARY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
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 1:774 LANDA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6114
Mailing Address - Country:US
Mailing Address - Phone:830-625-0305
Mailing Address - Fax:830-625-2693
Practice Address - Street 1:774 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6114
Practice Address - Country:US
Practice Address - Phone:830-625-0305
Practice Address - Fax:830-625-2693
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83X650OtherBLUE CROSS BLUE SHIELD
TX83X650Medicare ID - Type UnspecifiedMEDICARE ISSUED
TX83X650OtherBLUE CROSS BLUE SHIELD