Healthcare Provider Details

I. General information

NPI: 1649275652
Provider Name (Legal Business Name): ALEXANDER JAMES BYRNE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER JAMES BYRNE M.D

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E GRACE ST
PUNTA GORDA FL
33950-6121
US

IV. Provider business mailing address

3301 DIAMOND KEY CT
PUNTA GORDA FL
33955-4656
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-1181
  • Fax:
Mailing address:
  • Phone: 941-575-8046
  • Fax: 941-575-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME59876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME59876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: