Provider Demographics
NPI:1053355727
Name:BYRON, ROBERT GORDON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GORDON
Last Name:BYRON
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 1:10 4TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1802
Mailing Address - Country:US
Mailing Address - Phone:406-665-4103
Mailing Address - Fax:
Practice Address - Street 1:10 4TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1802
Practice Address - Country:US
Practice Address - Phone:406-665-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1255617130OtherBIGHORN VALLEY HEALTH CENTER NPI