Provider Demographics
NPI:1285631580
Name:BIRNBAUM, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-1988
Mailing Address - Country:US
Mailing Address - Phone:775-635-2550
Mailing Address - Fax:775-635-2437
Practice Address - Street 1:535 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-1988
Practice Address - Country:US
Practice Address - Phone:775-635-2550
Practice Address - Fax:775-635-2437
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-16207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29507367Medicaid
ILK07123Medicare PIN
NM29507367Medicaid
ILD14482Medicare UPIN