Provider Demographics
NPI:1063740884
Name:BIRDNO, CURTIS VANCE (PA-C)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:VANCE
Last Name:BIRDNO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7827
Mailing Address - Country:US
Mailing Address - Phone:928-532-1605
Mailing Address - Fax:928-532-2197
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7827
Practice Address - Country:US
Practice Address - Phone:928-532-1605
Practice Address - Fax:928-532-2197
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL-2945363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ189695Medicare PIN
CO02679221Medicaid