Healthcare Provider Details

I. General information

NPI: 1407963796
Provider Name (Legal Business Name): BYRON LEE LIMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14615 SAN PEDRO AVE SUITE 210
SAN ANTONIO TX
78232-4374
US

IV. Provider business mailing address

4630 N LOOP 1604 W STE 316
SAN ANTONIO TX
78249-1373
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-9929
  • Fax: 210-496-6699
Mailing address:
  • Phone: 210-496-9929
  • Fax: 210-496-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberH8212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: