Healthcare Provider Details

I. General information

NPI: 1477796936
Provider Name (Legal Business Name): PETER ANDREW BYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR. RALEIGH BLVD-304 EVMS EMERGENCY MEDICINE-
NORFOLK VA
23507-1999
US

IV. Provider business mailing address

106 BLANCA AVE EVMS EMERGENCY MEDICINE-
ALAMOSA CO
81101-2340
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number56190
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: