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
1	207Q00000X	Family Medicine Physician	01058714A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000325459	OTHER	IN	BCBS PIN
2	MEDICAID 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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