Individual
JONATHON M BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
255 BODERMAN, BLOOMSDALE, MO 63627-9099
(573) 483-9492
Mailing address
255 BODERMAN, BLOOMSDALE, MO 63627-9099
(573) 483-9492
(573) 483-9612
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R9D20
MO
207Q00000X
Family Medicine Physician
Primary
R9D20
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196690
BLUE CROSS BLUE SHIELD
—
05
—
202450847
—
MO
05
—
202450854
—
MO
Enumeration date
09/16/2005
Last updated
02/26/2021
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