Provider Demographics
NPI:1932179017
Name:BIRKLEY, DWIGHT L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:L
Last Name:BIRKLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:712-234-8787
Mailing Address - Fax:712-234-8777
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-234-8787
Practice Address - Fax:712-234-8777
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28651OtherWELLMARK BCBS IOWA
10375OtherMIDLANDS CHOICE
P00388037OtherMEDICARE RAILROAD
IAS64581Medicare UPIN
P00388037OtherMEDICARE RAILROAD