Provider Demographics
NPI:1962470377
Name:BYRD, LINDA (RT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-1358
Mailing Address - Country:US
Mailing Address - Phone:208-667-9334
Mailing Address - Fax:208-664-2341
Practice Address - Street 1:1021 9TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3433
Practice Address - Country:US
Practice Address - Phone:208-667-9334
Practice Address - Fax:208-664-2341
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYGN 0769-112085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYGN 0769-11OtherLICENSE
P00296788OtherRR MEDICARE
WY10355Medicare ID - Type UnspecifiedWY MEDICARE