Healthcare Provider Details

I. General information

NPI: 1376510560
Provider Name (Legal Business Name): CHARLES ALAN BYRON PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HARRISON AVE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

4120 DEERPOINT LAKE DR
PANAMA CITY FL
32409-2164
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1668
  • Fax: 850-785-2123
Mailing address:
  • Phone: 850-769-1668
  • Fax: 850-785-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: