Provider Demographics
NPI:1174100093
Name:BIRD'S EYE MEDICAL
Entity type:Organization
Organization Name:BIRD'S EYE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-556-6581
Mailing Address - Street 1:2915 29TH AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6183
Mailing Address - Country:US
Mailing Address - Phone:360-556-6581
Mailing Address - Fax:360-688-7015
Practice Address - Street 1:2915 29TH AVE SW STE A
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6183
Practice Address - Country:US
Practice Address - Phone:360-818-9592
Practice Address - Fax:360-688-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8396616Medicaid