Provider Demographics
NPI:1881676070
Name:BYRNS, JAMIA E (MD)
Entity Type:Individual
Prefix:
First Name:JAMIA
Middle Name:E
Last Name:BYRNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 SE 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7411
Mailing Address - Country:US
Mailing Address - Phone:845-596-9473
Mailing Address - Fax:
Practice Address - Street 1:13960 W WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1969
Practice Address - Country:US
Practice Address - Phone:208-947-5390
Practice Address - Fax:208-947-3465
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10603208M00000X, 207R00000X
IN01071764A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
33025FMedicare ID - Type Unspecified