Healthcare Provider Details

I. General information

NPI: 1316937998
Provider Name (Legal Business Name): WILLIAM A BYRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 GREENWOOD RD
SHREVEPORT LA
71103-3907
US

IV. Provider business mailing address

2611 GREENWOOD RD
SHREVEPORT LA
71103-3907
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-2020
  • Fax: 318-621-3023
Mailing address:
  • Phone: 318-631-2020
  • Fax: 318-621-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14814
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: