Provider Demographics
NPI:1801964630
Name:BYRD, ROBERT WOOD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WOOD
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 NEW CUT RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-8404
Mailing Address - Country:US
Mailing Address - Phone:270-783-4202
Mailing Address - Fax:
Practice Address - Street 1:1725 MCINTOSH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1037
Practice Address - Country:US
Practice Address - Phone:270-793-9229
Practice Address - Fax:270-793-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34304208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051792OtherANTHEM BCBS
KY2500010452OtherRR MEDICARE
KY64343403Medicaid
KY1159636OtherPASSPORT MEDICAID
KY2300063OtherUMWA
KY8201OtherKENTUCKY WC
KYH05188Medicare UPIN
KY1740201Medicare ID - Type Unspecified
KYK135191Medicare PIN