Healthcare Provider Details

I. General information

NPI: 1730769605
Provider Name (Legal Business Name): DOMINICK BYRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOMINICK BYRD MSC10 5610, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

DOMINICK BYRD MSC10 5610, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-7590
  • Fax: 505-272-3699
Mailing address:
  • Phone: 505-272-7590
  • Fax: 505-272-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2021-0413
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: