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Organization
LAURA BIRD, MD, LLC
Active
Organization
LAURA BIRD, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BIRD (OFFICE MANAGER)
(618) 288-0656
Entity
Organization
Contact information
Practice address
2704 N CENTER ST, MARYVILLE, IL 62062-5624
(618) 288-0656
(618) 288-0736
Mailing address
2704 N CENTER ST, MARYVILLE, IL 62062-5624
(618) 288-0656
(618) 288-0736
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096129
—
IL
Enumeration date
03/29/2007
Last updated
07/01/2008
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