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NPI Code Detail

MEDICARE: JAMES WILLARD BYRD D.O.

MEDICARE: JAMES WILLARD BYRD D.O.
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
12084P0800XPsychiatry PhysicianMO110526MO
22084P0804XChild & Adolescent Psychiatry Physician110526MO

Other Identifiers

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

General Provider Information

NPI Number : 1730191701
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WILLARD BYRD D.O.
Provider Business Mailing Address
First Line : 9979 WINGHAVEN BLVD
Second Line : SUITE 202
City : O FALLON
State : MO
Zip : 63368-3627
Country : US
Telephone Number : 314-909-1444
Fax Number : 636-240-4904
Provider Business Practice Location Address
First Line : 1032 CROSSWINDS CT
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-4836
Country : US
Telephone Number : 888-403-1071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 10/23/2018

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