Healthcare Provider Details

I. General information

NPI: 1235110503
Provider Name (Legal Business Name): JAMES R BYRN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N TILLOTSON AVE
MUNCIE IN
47304-3900
US

IV. Provider business mailing address

205 N TILLOTSON AVE
MUNCIE IN
47304-3900
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1995
  • Fax: 765-281-9114
Mailing address:
  • Phone: 765-288-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01024076
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: