Provider Demographics
NPI:1205855582
Name:BYNUM, MAX M (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:M
Last Name:BYNUM
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 1:20111 CEDAR ROAD NORTH
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-533-7400
Mailing Address - Fax:209-533-7406
Practice Address - Street 1:20111 CEDAR RD N
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5939
Practice Address - Country:US
Practice Address - Phone:209-533-7400
Practice Address - Fax:209-533-7406
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-24696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist