Provider Demographics
NPI:1093787756
Name:MACHEN, BYRON C (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:C
Last Name:MACHEN
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 1:2055 NORMANDIE DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000104062085R0202X
FLME896462085R0202X
AL104062085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000075746Medicaid
AL009945575Medicaid
AL000035476Medicaid
AL009973475Medicaid
AL106719Medicaid
AL000035477Medicaid
AL009951035Medicaid
AL106718Medicaid
AL000035482Medicaid
AL108378Medicaid
FL270022100Medicaid
AL000035479Medicaid
AL000058867OtherIDTF
AL051504364OtherIDTF
AL009945565Medicaid
AL108197Medicaid
AL000035478Medicaid
AL009932755Medicaid
AL009945585Medicaid
AL108378Medicaid
FL37501ZMedicare PIN
AL000058867OtherIDTF
AL009945575Medicaid
AL000035478Medicaid
AL000075746Medicare PIN