Provider Demographics
NPI:1992200331
Name:BIRD, SCOTT GREGORY (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GREGORY
Last Name:BIRD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:479-573-7905
Mailing Address - Fax:479-573-7906
Practice Address - Street 1:5428 ELLSWORTH RD STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3220
Practice Address - Country:US
Practice Address - Phone:479-573-7905
Practice Address - Fax:479-573-7906
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR279213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist