Provider Demographics
NPI:1083760284
Name:BIRD, CHARLES BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:SILETZ
Mailing Address - State:OR
Mailing Address - Zip Code:97380-9620
Mailing Address - Country:US
Mailing Address - Phone:541-444-7585
Mailing Address - Fax:541-444-1121
Practice Address - Street 1:54 LEISURE LN
Practice Address - Street 2:
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380-9620
Practice Address - Country:US
Practice Address - Phone:541-444-7585
Practice Address - Fax:541-444-1121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07134207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery