Provider Demographics
NPI:1689969735
Name:BYRD, ADAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:C
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:313 N COURT AVE
Mailing Address - Street 2:UMMC - DERMATOLOGY LOUISVILLE
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339
Mailing Address - Country:US
Mailing Address - Phone:601-815-3374
Mailing Address - Fax:601-815-0439
Practice Address - Street 1:313 N COURT AVE
Practice Address - Street 2:UMMC DERMATOLOGY - LOUISVILLE CLINIC
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339
Practice Address - Country:US
Practice Address - Phone:601-815-3374
Practice Address - Fax:601-815-0439
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24305207N00000X, 207N00000X
MN55869207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06383271Medicaid
MSP01696336OtherRAILROAD MEDICARE PTAN
MS516740YJ5DMedicare PIN