Provider Demographics
NPI:1760477160
Name:BIRDWELL, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 OAKMONT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3908
Mailing Address - Country:US
Mailing Address - Phone:817-370-0400
Mailing Address - Fax:817-370-0448
Practice Address - Street 1:7100 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3908
Practice Address - Country:US
Practice Address - Phone:817-370-0400
Practice Address - Fax:817-370-0448
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131569905Medicaid
TX080463501Medicaid
TX84470KMedicare PIN
TX455039YKPWMedicare PIN
TX00370KMedicare PIN
C13468Medicare UPIN