Healthcare Provider Details

I. General information

NPI: 1073592911
Provider Name (Legal Business Name): JOHN J BYRD JR. PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7722
  • Fax: 410-543-7725
Mailing address:
  • Phone: 410-543-7722
  • Fax: 410-543-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002938
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: