Provider Demographics
NPI:1124009022
Name:BYRNE, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BYRNE
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-739-4166
Mailing Address - Fax:314-739-2485
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 700
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-4166
Practice Address - Fax:314-739-2485
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J78207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0400915OtherUHC
MO202580312Medicaid
MO11011OtherBCBS
MO5241272OtherAETNA
MOB18388OtherMERCY
MO000000010010OtherESSENCE
MO000000012459OtherESSENCE ST CHARLES
127465OtherGHP
MOD04003OtherEXCLUSIVE CHOICE
0403000OtherUHC MEDICARE COMPLETE
165438OtherHEALTHLINK
MO165438OtherHEALTHLINK
MO0400915OtherUHC
MO165438OtherHEALTHLINK
0403000OtherUHC MEDICARE COMPLETE