Provider Demographics
NPI:1578729968
Name:C. RON BYRD, MD PA
Entity Type:Organization
Organization Name:C. RON BYRD, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RON
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-328-2752
Mailing Address - Street 1:2765 BEE CAVE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5640
Mailing Address - Country:US
Mailing Address - Phone:512-328-2752
Mailing Address - Fax:512-328-2751
Practice Address - Street 1:2712 BEE CAVES RD STE 122
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5662
Practice Address - Country:US
Practice Address - Phone:512-328-2752
Practice Address - Fax:512-328-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG02262Medicare UPIN