Provider Demographics
NPI:1164638573
Name:BIRD, GARRETT (MD, CM)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD, CM
Other - Prefix:
Other - First Name:GARRETT
Other - Middle Name:REED
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4063 W 12600 S # SABS
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7302
Mailing Address - Country:US
Mailing Address - Phone:801-935-8180
Mailing Address - Fax:801-931-2307
Practice Address - Street 1:4063 W 12600 S # SABS
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7302
Practice Address - Country:US
Practice Address - Phone:801-935-8180
Practice Address - Fax:801-931-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC2163207RC0200X
CAA97356207RC0200X
UT8200519-1205207RC0200X, 207RP1001X, 207RS0012X
LA339668207RC0200X, 207RP1001X
GA98100207RC0200X
TXN9024207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease