Provider Demographics
NPI:1649382052
Name:CHRIS M BYRNE DPM INC
Entity Type:Organization
Organization Name:CHRIS M BYRNE DPM INC
Other - Org Name:SAN LUIS PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-543-7788
Mailing Address - Street 1:1551 BISHOP ST
Mailing Address - Street 2:STE 210B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-543-7788
Mailing Address - Fax:805-543-7828
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:STE B210
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-543-7788
Practice Address - Fax:805-543-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4236213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4236CMedicare ID - Type Unspecified
U46231Medicare UPIN
4654890001Medicare NSC