Provider Demographics
NPI:1518253699
Name:BAPTIST, BYRON DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:DOMINIC
Last Name:BAPTIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR STE 280
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-432-4415
Mailing Address - Fax:314-432-1986
Practice Address - Street 1:12855 N 40 DR STE 280
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-432-4415
Practice Address - Fax:314-432-1986
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014022609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine