Provider Demographics
NPI:1942531454
Name:DAVIS, BYRON LYN (IDC)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:LYN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 SHORELINE CIR
Mailing Address - Street 2:APT 121
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2169
Mailing Address - Country:US
Mailing Address - Phone:336-269-4781
Mailing Address - Fax:
Practice Address - Street 1:USS BAINBRIDGE (DDG 96)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09565-1303
Practice Address - Country:US
Practice Address - Phone:757-444-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman