Provider Demographics
NPI:1790844348
Name:BIRD, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:COND. TORRE DE AUXILIO MUTUO
Mailing Address - Street 2:SUITE 711 AVE. PONCE DE LEON # 735
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5030
Mailing Address - Country:US
Mailing Address - Phone:787-765-2563
Mailing Address - Fax:787-274-1886
Practice Address - Street 1:COND. TORRE DE AUXILIO MUTUO
Practice Address - Street 2:SUITE 711 AVE. PONCE DE LEON # 735
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5030
Practice Address - Country:US
Practice Address - Phone:787-765-2563
Practice Address - Fax:787-274-1886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2017-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR9343207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
E04131Medicare UPIN
PR81430Medicare ID - Type Unspecified