Provider Demographics
NPI:1235152141
Name:BYRD, WILFORD HALE (MD)
Entity Type:Individual
Prefix:
First Name:WILFORD
Middle Name:HALE
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 1:1132 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9446
Mailing Address - Country:US
Mailing Address - Phone:601-664-1620
Mailing Address - Fax:601-664-1624
Practice Address - Street 1:1132 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9446
Practice Address - Country:US
Practice Address - Phone:601-664-1620
Practice Address - Fax:601-664-1624
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122360Medicaid
MS0122360Medicaid