Provider Demographics
NPI:1326020082
Name:BYRNE, KEVIN GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GERARD
Last Name:BYRNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 NICHOLS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3008
Mailing Address - Country:US
Mailing Address - Phone:573-302-7138
Mailing Address - Fax:573-302-7123
Practice Address - Street 1:1029 NICHOLS RD STE 201
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3008
Practice Address - Country:US
Practice Address - Phone:573-302-7138
Practice Address - Fax:573-302-7123
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO107693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110198631OtherRR MEDICARE
MO247961113Medicaid
MOE71349Medicare UPIN
MO946535368Medicare PIN