Provider Demographics
NPI:1538108147
Name:BYRD, RICHARD WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 VALLEY FORGE ST
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-1815
Mailing Address - Country:US
Mailing Address - Phone:325-356-5595
Mailing Address - Fax:325-356-3809
Practice Address - Street 1:201 VALLEY FORGE ST
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-1815
Practice Address - Country:US
Practice Address - Phone:325-356-5595
Practice Address - Fax:325-356-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1333908-03Medicaid
TXQV17Medicare ID - Type Unspecified
TXC14038Medicare UPIN
TX1333908-03Medicaid