MEDICARE: DR. BYRON F CONNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J8496	TX
2	207P00000X	Emergency Medicine Physician	J8496	TX
3	2083P0901X	Public Health & General Preventive Medicine Physician	J8496	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00802556	OTHER	TX	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669412243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON F CONNER M.D.

Provider Business Mailing Address
First Line	:	4551 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2628
Country	:	US
Telephone Number	:	817-644-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2628
Country	:	US
Telephone Number	:	817-644-3340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	02/13/2015

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