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NPI Code Detail

MEDICARE: COLIN BYRD D.O.

MEDICARE: COLIN BYRD D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YS0123XFacial Plastic Surgery Physician5101023512MI
2207YS0123XFacial Plastic Surgery Physician5315087403MI
3390200000XStudent in an Organized Health Care Education/Training Program
4207Y00000XOtolaryngology PhysicianDO2022-0077NM

General Provider Information

NPI Number : 1063951689
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLIN BYRD D.O.
Provider Business Mailing Address
First Line : 50 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48342-2217
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2450 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5076
Country : US
Telephone Number : 575-522-8641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2017
Last Update Date : 03/11/2023

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