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General NPI Number Information
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NPI Number | 1992064026
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Entity Type | Individual
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Provider Name | GEORGE WAYNE BYRAM III M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 1455 E BERT KOUNS INDUSTRIAL LOOP # 210
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 187-984-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 E BERT KOUNS INDUSTRIAL LOOP # 210
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City | SHREVEPORT
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State | LA
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Zip | 71105-6000
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Country | US
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Telephone | 318-423-4482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD.308290
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 24984
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License Number State | MS
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