Provider Demographics
NPI:1821384843
Name:BYRON, SAMUEL HUGH (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HUGH
Last Name:BYRON
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 1:405 W GRAND AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4720
Mailing Address - Country:US
Mailing Address - Phone:937-723-4031
Mailing Address - Fax:937-461-0020
Practice Address - Street 1:2050 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1405
Practice Address - Country:US
Practice Address - Phone:859-257-3573
Practice Address - Fax:859-323-0096
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05404204D00000X, 208100000X
KYTP240208100000X
OH34.011803204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125268Medicaid
OHH444800Medicare PIN