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General NPI Number Information
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NPI Number | 1053610923
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Entity Type | Individual
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Provider Name | BYRON LAYNE STAPLETON DO
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Gender | Male
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 300 HEALTH PARK BLVD STE 5002
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City | ST AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-819-5861
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Fax | 904-819-5862
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Provider Business Mailing Address
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Address Line | PO BOX 3266
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3266
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Country | US
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Telephone | 904-819-4602
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Fax | 904-819-4426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34.012166
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS16229
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License Number State | FL
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