Healthcare Provider Details

I. General information

NPI: 1821384843
Provider Name (Legal Business Name): SAMUEL HUGH BYRON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

405 W GRAND AVE FIRST FLOOR
DAYTON OH
45405-4720
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3573
  • Fax: 859-323-0096
Mailing address:
  • Phone: 937-723-4031
  • Fax: 937-461-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number05404
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberTP240
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number05404
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34.011803
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.011803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: