Provider Demographics
NPI:1649275652
Name:BYRNE, ALEXANDER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JAMES
Last Name:BYRNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:JAMES
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3301 DIAMOND KEY CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-4656
Mailing Address - Country:US
Mailing Address - Phone:941-575-8046
Mailing Address - Fax:941-575-7159
Practice Address - Street 1:514 E GRACE ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6121
Practice Address - Country:US
Practice Address - Phone:941-639-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59876207Q00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257828000Medicaid
FL257828000Medicaid
FLE3914ZMedicare ID - Type Unspecified