Provider Demographics
NPI:1548369853
Name:BYRD, RICHARD GORMAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GORMAN
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7128
Mailing Address - Country:US
Mailing Address - Phone:760-568-5949
Mailing Address - Fax:760-568-6422
Practice Address - Street 1:74785 US HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7128
Practice Address - Country:US
Practice Address - Phone:760-568-5949
Practice Address - Fax:760-568-6422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42098OtherSTATE MEDICAL LICENSE
CAG42098OtherSTATE MEDICAL LICENSE
CAG42098OtherSTATE MEDICAL LICENSE