Individual
JERRY DOUGLAS BYRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C6800
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11282000000
QUALCHOICE
AR
05
—
114501001
—
AR
01
—
4208764
AETNA
AR
01
—
516264
HEALTHLINK
AR
Enumeration date
04/13/2006
Last updated
11/03/2011
Update your record
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