Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3108 | AR |
NPI | 1245418292 |
---|---|
Provider Name | Jeff H Byram |
First Address | Searcy, AR 72143 |
Second Address | Searcy, AR 72143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2008 |
Last Update Date | 27/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12801679 | (05) | AR |
U49977 | (02) | AR |