Provider Demographics
NPI:1265534028
Name:BIRD, THOMAS DWIGHT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DWIGHT
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF WASHINGTON
Mailing Address - Street 2:BOX 356465
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-4030
Mailing Address - Fax:206-764-2569
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:GRECC182
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-4522
Practice Address - Fax:206-764-2569
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00011262204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100472Medicare ID - Type Unspecified
WAAO4085Medicare UPIN