Provider Demographics
NPI:1659344976
Name:BYRNE, VINCENT R (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:R
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 32950
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064
Mailing Address - Country:US
Mailing Address - Phone:602-433-1822
Mailing Address - Fax:602-246-7060
Practice Address - Street 1:8260 W INDIAN SCHOOL
Practice Address - Street 2:STE 1 & 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:623-846-7122
Practice Address - Fax:623-846-7027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9595207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ022062Medicaid
105777OtherMEDICARE PIN
AZ022062Medicaid