Provider Demographics
NPI:1942697149
Name:BYRT, CONOR WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:WILLIAM
Last Name:BYRT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9181 TOWN SQUARE BLVD APT 2324
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1235
Mailing Address - Country:US
Mailing Address - Phone:518-269-6139
Mailing Address - Fax:
Practice Address - Street 1:21731 SOUND WAY
Practice Address - Street 2:102
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928
Practice Address - Country:US
Practice Address - Phone:518-269-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306345207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program