Healthcare Provider Details

I. General information

NPI: 1467569368
Provider Name (Legal Business Name): ROBERT ROLAND BYERLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 E 22ND ST
TUCSON AZ
85710-8509
US

IV. Provider business mailing address

655 E RIVER RD
TUCSON AZ
85704-5840
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8400
  • Fax: 520-694-9424
Mailing address:
  • Phone: 520-694-2748
  • Fax: 520-684-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL6811
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31607
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: