Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 44959 | TN |
NPI | 1124175948 |
---|---|
Provider Name | Ian R Byram |
First Address | Nashville, TN 37232-5100 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I238941 | MEDICARE (01) | TN |