Basic Information
| Provider Information | |||||||||
| NPI: | 1659358000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRDSELL | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | NANCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840853 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727155000 | ||||||||
| FaxNumber: | 9727155000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PENNSYLVANIA AVE. | ||||||||
| Address2: | SRP 2 - ROOM 73 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727155000 | ||||||||
| FaxNumber: | 9727159976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G7436 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 8EH322 | 01 | TX | BCBS | OTHER | 129329208 | 05 | TX | MEDICAID | 129329202 | 05 | TX | MEDICAID | 129329201 | 05 | TX | MEDICAID | 129329207 | 05 | TX | MEDICAID | 129329210 | 05 | TX | MEDICAID | 83878K | 01 | TX | BCBS | OTHER | 050065318 | 01 | TX | RAILROAD | OTHER | 129329209 | 05 | TX | MEDICAID |