Healthcare Provider Details

I. General information

NPI: 1487609624
Provider Name (Legal Business Name): LARRY N BYRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 ARDEN LN STE 100
ROCK HILL SC
29732-2995
US

IV. Provider business mailing address

724 ARDEN LN STE 100
ROCK HILL SC
29732-2995
US

V. Phone/Fax

Practice location:
  • Phone: 803-980-7337
  • Fax: 803-980-2229
Mailing address:
  • Phone: 803-980-7337
  • Fax: 803-980-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14759
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: