Healthcare Provider Details

I. General information

NPI: 1548369853
Provider Name (Legal Business Name): RICHARD GORMAN BYRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 SUITE 101
INDIAN WELLS CA
92210-7128
US

IV. Provider business mailing address

74785 US HIGHWAY 111 SUITE 101
INDIAN WELLS CA
92210-7128
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-5949
  • Fax: 760-568-6422
Mailing address:
  • Phone: 760-568-5949
  • Fax: 760-568-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG42098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: