Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 27308 | MN |
Y | 208600000X | Surgeon | 27308 | MN |
NPI | 1003849092 |
---|---|
Provider Name | Roderick Ralph Byron |
First Address | Faribault, MN 55021-5441 |
Second Address | Faribault, MN 55021-5441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 14/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020045514 | RAIL ROAD MEDICARE (01) | |
088448100 | (05) | MN |
A89989 | (02) |