Basic Information
| Provider Information | |||||||||
| NPI: | 1053355727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BYRON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 4TH ST W | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HARDIN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590341802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066654103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 4TH ST W | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HARDIN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590341802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066654103 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 6265 | MT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1255617130 | 01 | MT | BIGHORN VALLEY HEALTH CENTER NPI | OTHER |