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NPI Code Detail

MEDICARE: SAMUEL J BYRD M.D.

MEDICARE: SAMUEL J BYRD M.D.
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
1207Q00000XFamily Medicine Physician01058714AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000325459OTHERINBCBS PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790788081
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL J BYRD M.D.
Provider Business Mailing Address
First Line : PO BOX 665
Second Line :
City : VINCENNES
State : IN
Zip : 47591-0665
Country : US
Telephone Number : 812-882-2400
Fax Number : 812-882-2422
Provider Business Practice Location Address
First Line : 1621 WILLOW ST
Second Line :
City : VINCENNES
State : IN
Zip : 47591-4211
Country : US
Telephone Number : 812-882-2400
Fax Number : 812-882-2422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 05/17/2011

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