Basic Information
| Provider Information | |||||||||
| NPI: | 1124006671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYARS | ||||||||
| FirstName: | CHAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9155 SW BARNES RD | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032976334 | ||||||||
| FaxNumber: | 5032972360 | ||||||||
| Practice Location | |||||||||
| Address1: | 10150 SE 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972226516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035131031 | ||||||||
| FaxNumber: | 5035138469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35075203 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD27144 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2138332 | 05 | OH | MEDICAID |