Provider Demographics
NPI:1922637560
Name:BYRON, FENOLD
Entity Type:Individual
Prefix:
First Name:FENOLD
Middle Name:
Last Name:BYRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TRAVIS ST APT 35
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6663
Mailing Address - Country:US
Mailing Address - Phone:956-225-9494
Mailing Address - Fax:
Practice Address - Street 1:900 TRAVIS ST APT 35
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6663
Practice Address - Country:US
Practice Address - Phone:956-225-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR621-P.A.207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine