Healthcare Provider Details

I. General information

NPI: 1649373994
Provider Name (Legal Business Name): CYNTHIA D BYLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD DES PERES RD SUITE 100
SAINT LOUIS MO
63131-1873
US

IV. Provider business mailing address

1050 OLD DES PERES RD SUITE 100
SAINT LOUIS MO
63131-1873
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0612
  • Fax: 314-966-0664
Mailing address:
  • Phone: 314-569-0612
  • Fax: 314-966-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDO R1G13
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: