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General NPI Number Information
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NPI Number | 1114192754
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Entity Type | Organization
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Legal Business Name | ROCHESTER DERMATOLOGY CLINIC, P.C.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 405 BARCLAY CIR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4573
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Country | US
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Telephone | 248-843-3131
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Fax | 248-853-3275
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Provider Business Mailing Address
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Address Line | 56853 MOUNT VERNON RD
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City | SHELBY TWP
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State | MI
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Zip | 48316-4829
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Country | US
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Telephone | 248-652-3926
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Fax | 248-853-3275
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER CLARENCE BYRD
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Credential | D.O.
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Telephone | 248-853-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 5101005759
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License Number State | MI
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