Basic Information
| Provider Information | |||||||||
| NPI: | 1487620654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRUM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
| FaxNumber: | 3365471828 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471801 | ||||||||
| FaxNumber: | 3365471828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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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 | 207P00000X | 41555 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RP1001X | 2006-00801 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 85603082 | 05 | CO | MEDICAID |