Provider Demographics
NPI:1972675825
Name:BYRNE, JAMES J
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:BYRNE
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:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32759
Mailing Address - Country:US
Mailing Address - Phone:386-345-0003
Mailing Address - Fax:386-345-0007
Practice Address - Street 1:185 NORTH ROUTE 1
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:FL
Practice Address - Zip Code:32141
Practice Address - Country:US
Practice Address - Phone:386-345-0003
Practice Address - Fax:386-345-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003901208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037162900Medicaid
FL037162901Medicaid
FL660132400OtherMEDICAID RURAL HEALTH
108925OtherMEDICARE RURAL HEALTH
FL82210AMedicare ID - Type Unspecified
FL037162901Medicaid