Provider Demographics
NPI:1669479168
Name:BYNUM, GAITHER D (MD)
Entity Type:Individual
Prefix:
First Name:GAITHER
Middle Name:D
Last Name:BYNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:101 PEABODY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-1061
Practice Address - Country:US
Practice Address - Phone:605-345-4141
Practice Address - Fax:605-345-4135
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD3770207P00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611740Medicaid
SDS100644Medicare PIN
SD5611740Medicaid