Provider Demographics
NPI:1396714119
Name:BYRON, GARLAND EDWARD (MD)
Entity type:Individual
Prefix:
First Name:GARLAND
Middle Name:EDWARD
Last Name:BYRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:1 WALTER SCHOLER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-6303
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8262
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029094A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10824861OtherCAQH NUMBER
IN000000193056OtherANTHEM PROVIDER NUMBER
IN9396901OtherPHCS PID NUMBER
IN100231400Medicaid
INBY80513029Medicaid
IN110166364Medicare PIN
IN9396901OtherPHCS PID NUMBER
IN000000193056OtherANTHEM PROVIDER NUMBER
INE03841Medicare UPIN