Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 5101023512 | MI |
N | 207YS0123X | Facial Plastic Surgeon | 5315087403 | MI |
NPI | 1063951689 |
---|---|
Provider Name | Colin Byrd |
First Address | Pontiac, MI 48342-2217 |
Second Address | Pontiac, MI 48342-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 27/06/2017 |