Healthcare Provider Details

I. General information

NPI: 1881238541
Provider Name (Legal Business Name): BRYAN EDWARD BYRD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 401
ORLANDO FL
32804-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax: 407-303-0347
Mailing address:
  • Phone: 407-303-7283
  • Fax: 407-303-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113076
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13355
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: