Provider Demographics
NPI:1821070236
Name:BYRD, OLIVER WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:WAYNE
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5208
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5208
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:603 S ARCHUSA AVE
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2331
Practice Address - Country:US
Practice Address - Phone:601-776-2123
Practice Address - Fax:601-776-6006
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080185587OtherRAILROAD MEDICARE
MS00016364Medicaid
730-07884OtherBLUE CROSS OF AL
B30649Medicare UPIN
MS00016364Medicaid