Provider Demographics
NPI:1063707966
Name:BYRD, JONATHAN NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NICHOLAS
Last Name:BYRD
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Gender:
Credentials:MD
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Mailing Address - Street 1:PO BOX 7412037
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2037
Mailing Address - Country:US
Mailing Address - Phone:314-333-4100
Mailing Address - Fax:314-333-4115
Practice Address - Street 1:4320 FOREST PARK AVE
Practice Address - Street 2:STE 1100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2979
Practice Address - Country:US
Practice Address - Phone:314-333-4100
Practice Address - Fax:314-333-4115
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2025-04-15
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Provider Licenses
StateLicense IDTaxonomies
MO2014004993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200016739Medicaid