Provider Demographics
NPI:1518901446
Name:BYRD, JESSE RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:RANDALL
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 1:1614 HWY 56
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8297
Mailing Address - Country:US
Mailing Address - Phone:919-575-6103
Mailing Address - Fax:919-575-6817
Practice Address - Street 1:1614 HWY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8297
Practice Address - Country:US
Practice Address - Phone:919-575-6103
Practice Address - Fax:919-575-6817
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33000207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine