Provider Demographics
NPI:1750546289
Name:BIRD, DOUGLAS JOHN (PA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:BIRD
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4102 PINION DRIVE
Mailing Address - Street 2:10TH MEDICAL GROUP
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5250
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DRIVE
Practice Address - Street 2:10TH MEDICAL GROUP
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2017-01-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082401OtherNCCPA