Provider Demographics
NPI:1912966771
Name:BYRD, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2751 ALBERT L BICKNELL DR
Mailing Address - Street 2:SUITE 3-D
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3920
Mailing Address - Country:US
Mailing Address - Phone:318-221-4755
Mailing Address - Fax:318-424-3642
Practice Address - Street 1:2751 ALBERT L BICKNELL DR
Practice Address - Street 2:STE. 3-D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3920
Practice Address - Country:US
Practice Address - Phone:318-221-4755
Practice Address - Fax:318-424-3642
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LACDS.005128-MD208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1113361Medicaid
LAB62596Medicare UPIN
LA1113361Medicaid