Individual
DR. JUAN C BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10080 SW INNOVATION WAY STE 201, PORT ST LUCIE, FL 34987-2129
(772) 283-9111
(772) 283-2955
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-2955
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
18180
PR
207RG0100X
Gastroenterology Physician
MD043743
DC
207RG0100X
Gastroenterology Physician
Primary
ME133140
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IEUU3
FLORIDA BLUE
FL
Enumeration date
05/13/2009
Last updated
10/14/2020
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