Provider Demographics
NPI:1356339618
Name:BYRD, RANDOLPH COTTON (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:COTTON
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-0200
Mailing Address - Fax:208-302-0255
Practice Address - Street 1:4424 E FLAMINGO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9306
Practice Address - Country:US
Practice Address - Phone:208-302-0200
Practice Address - Fax:208-302-0255
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-6985207RC0000X
CO32416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO492138Medicare ID - Type Unspecified
COA45741Medicare UPIN