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Brian Bird

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NPI Number Detailed Information

Provider Information:

Name: Brian Bird
Gender: M
Provider License Number If Given: D-3837

NPI Information:

NPI: 1316931819
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 12/21/2015

Provider Business Mailing Address:

Address: 1744 N MITCHELL ST
Boise, ID 83704
Phone Number: 2088691038
Fax Number:

Provider Business Practice Location Address:

Address: 1744 N MITCHELL ST
Boise, ID 83704
Phone Number: 2088691038
Fax Number:

Provider Taxonomy:

Primary: 122300000X
Secondary (if any):
State: ID