Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 26286 | AL |
NPI | 1043205164 |
---|---|
Provider Name | Mark Allen Byard |
First Address | Dothan, AL 36305-1056 |
Second Address | Dothan, AL 36305-1056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051555203 | (05) | AL |
945575290A | (05) | GA |
D98054 | (02) | AL |