1093890220 NPI number — DR. ROBERT E BYRD D.C.

Table of content: DR. ROBERT E BYRD D.C. (NPI 1093890220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093890220 NPI number — DR. ROBERT E BYRD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRD
Provider First Name:
ROBERT
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093890220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 PENNSYLVANIA ST NE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-268-0808
Provider Business Mailing Address Fax Number:
505-268-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7611 INDIAN SCHOOL RD NE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-268-0808
Provider Business Practice Location Address Fax Number:
505-268-2458
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  NM1009 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM1009 . This is a "NEW MEXICO LICENSE NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM01K682 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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