Provider Demographics
NPI:1861840993
Name:BIRD, BRETT (PA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:PA
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 12330
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-2330
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:
Practice Address - Street 1:601 E HAMPDEN AVE STE 310
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2769
Practice Address - Country:US
Practice Address - Phone:855-863-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15667363A00000X
NVPA2614363A00000X
IDPA-2189363A00000X
COPA.0005328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant