Provider Demographics
NPI:1639862766
Name:PYNE, JUSTIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:PYNE
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 1:5323 HARRY HINES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390
Mailing Address - Country:US
Mailing Address - Phone:214-648-2432
Mailing Address - Fax:
Practice Address - Street 1:6420 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5925
Practice Address - Country:US
Practice Address - Phone:512-222-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-07-16
Deactivation Date:2024-01-05
Deactivation Code:
Reactivation Date:2024-01-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU6327207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program