Provider Demographics
NPI:1043275191
Name:ALEXANDER, BYRON B (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:B
Last Name:ALEXANDER
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 1:1640 CHARLES PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-0428
Mailing Address - Country:US
Mailing Address - Phone:785-539-4645
Mailing Address - Fax:785-539-1655
Practice Address - Street 1:1640 CHARLES PL
Practice Address - Street 2:SUITE 103
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2868
Practice Address - Country:US
Practice Address - Phone:785-539-4645
Practice Address - Fax:785-539-1655
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22575207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102952Medicare ID - Type Unspecified
KSE29273Medicare UPIN