Provider Demographics
NPI:1316937998
Name:BYRD, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2611 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3907
Mailing Address - Country:US
Mailing Address - Phone:318-631-2020
Mailing Address - Fax:318-621-3023
Practice Address - Street 1:2611 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3907
Practice Address - Country:US
Practice Address - Phone:318-631-2020
Practice Address - Fax:318-621-3023
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA14814207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321621Medicaid
5J349Medicare ID - Type Unspecified
B-60435Medicare UPIN