Provider Demographics
NPI:1639163629
Name:BYRNES, JOHN F JR (PA C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BYRNES
Suffix:JR
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 OCOEE APOPKA RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9210
Mailing Address - Country:US
Mailing Address - Phone:407-609-0095
Mailing Address - Fax:
Practice Address - Street 1:2100 OCOEE APOPKA RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9210
Practice Address - Country:US
Practice Address - Phone:407-609-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1679363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHF826AOtherMEDICARE GROUP PTAN
FL290007600Medicaid
FLE3714Medicare ID - Type Unspecified
FL290007600Medicaid
FLHF826AOtherMEDICARE GROUP PTAN