Provider Demographics
NPI:1619515608
Name:BYRD, EDDIE DEAN JR
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:DEAN
Last Name:BYRD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S DUNCAN BYP
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-7830
Mailing Address - Country:US
Mailing Address - Phone:864-429-3003
Mailing Address - Fax:864-429-3095
Practice Address - Street 1:720 S DUNCAN BYP
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-7830
Practice Address - Country:US
Practice Address - Phone:864-429-3003
Practice Address - Fax:864-429-3095
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3043208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation