Healthcare Provider Details

I. General information

NPI: 1194889139
Provider Name (Legal Business Name): JESSSICA EVELYN BYRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E LOWELL ST
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

2320 E MITCHELL ST
TUCSON AZ
85719-3200
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-4801
  • Fax: 520-626-5736
Mailing address:
  • Phone: 520-722-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAZ14202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: