Provider Demographics
NPI:1780655100
Name:BIRKETT, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BIRKETT
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-955-9200
Mailing Address - Fax:515-955-9201
Practice Address - Street 1:119 AVENUE O W
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5634
Practice Address - Country:US
Practice Address - Phone:515-955-9200
Practice Address - Fax:515-955-9201
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-20218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI3297Medicare PIN
A01248Medicare UPIN