Provider Demographics
NPI:1417956269
Name:BYERS, RICHARD H JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:BYERS
Suffix:JR
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 1:1157 N MONROE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1699
Mailing Address - Country:US
Mailing Address - Phone:937-374-3484
Mailing Address - Fax:937-374-7484
Practice Address - Street 1:1157 N MONROE DR STE 220
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1699
Practice Address - Country:US
Practice Address - Phone:937-374-3484
Practice Address - Fax:937-374-7484
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372994Medicaid
OHP00432946OtherRAILROAD MEDICARE
OH080079621OtherRAILROAD MEDICARE
OH000000012227OtherANTHEM
OH0372994Medicaid
OH0712354Medicare PIN