Provider Demographics
NPI:1104849439
Name:BYRD, TIMOTHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
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 1:2 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6518
Mailing Address - Country:US
Mailing Address - Phone:352-629-4350
Mailing Address - Fax:352-629-3070
Practice Address - Street 1:2 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6518
Practice Address - Country:US
Practice Address - Phone:352-629-4350
Practice Address - Fax:352-629-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00357512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54803Medicare UPIN
FL42169Medicare ID - Type Unspecified