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NPI Code Detail

MEDICARE: MARK ALLEN BYARD MD

MEDICARE: MARK ALLEN BYARD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician26286AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043205164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ALLEN BYARD MD
Provider Business Mailing Address
First Line : 4370 W MAIN ST
Second Line :
City : DOTHAN
State : AL
Zip : 36305-1056
Country : US
Telephone Number : 334-793-5000
Fax Number : 334-615-8418
Provider Business Practice Location Address
First Line : 4370 W MAIN ST
Second Line :
City : DOTHAN
State : AL
Zip : 36305-1056
Country : US
Telephone Number : 334-793-5000
Fax Number : 334-615-8418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 10/12/2020

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