Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | PA05445 | TX |
NPI | 1316136351 |
---|---|
Provider Name | Ms. Amanda Beth Byers |
First Address | Durango, CO 81301-7308 |
Second Address | Durango, CO 81301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142946601 | (05) | TX |
8Y3146 | BCBS (01) | TX |