| Doctor Name: | MARY NONE BIRDSONG |
| NPI Number: | 1265871495 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D, |
| License Number: | 83-163 |
| Business Practice Address: | 3901 Indian School Rd Ne Apt A207 Albuquerque, NM - 871103855 |
| Business Phone Number: | 5058768366 |
| Business Fax Number: | |
| Mailing Address: | Po Box 250, 2111 Lobo Canyon Rd GRANTS |
| State: | NM |
| Postal Code: | 870200250 |
| Phone Number: | 5058768366 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2013 |
| NPI Last Update Date: | 06/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 83-163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |