Provider Demographics
NPI:1619960515
Name:BYERS, JOHN GORDON JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GORDON
Last Name:BYERS
Suffix:JR
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 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 3W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-5583
Practice Address - Fax:423-844-5588
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010851207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3171970Medicaid
TN103I812922Medicare PIN
TND32074Medicare UPIN
TN3171971Medicare ID - Type Unspecified
TNP00412819Medicare PIN
TN3171973Medicare PIN