Provider Demographics
NPI:1902846629
Name:BYERS, JILL GERSPACH (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:GERSPACH
Last Name:BYERS
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2740
Mailing Address - Country:US
Mailing Address - Phone:949-515-3777
Mailing Address - Fax:949-480-3404
Practice Address - Street 1:320 SUPERIOR AVE STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2740
Practice Address - Country:US
Practice Address - Phone:949-515-3777
Practice Address - Fax:949-480-3404
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-17072208800000X
CAG74895208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74895OtherMEDICAL BOARD LICENSE
CAG74895OtherMEDICAL BOARD LICENSE
CA954886788OtherTIN
CAWG74895FMedicare PIN