Provider Demographics
NPI:1992731566
Name:BYRON, LORI GRIFFIN (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:GRIFFIN
Last Name:BYRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:JANE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:RT 1 BOX 1079
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034
Mailing Address - Country:US
Mailing Address - Phone:404-665-3088
Mailing Address - Fax:406-638-3572
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:CROW NORTHERN CHEYENNE INDIAN HOSPITAL
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3321
Practice Address - Fax:406-638-3572
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C76587Medicare UPIN