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General NPI Number Information
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NPI Number | 1417099219
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Entity Type | Organization
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Legal Business Name | T J BYRON DPM MS PODIATRIST GROUP INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26732 CROWN VALLEY PKWY SUITE 271
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6306
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Country | US
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Telephone | 949-364-3640
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Fax | 949-364-3630
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Provider Business Mailing Address
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Address Line | 26732 CROWN VALLEY PKWY SUITE 271
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6306
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Country | US
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Telephone | 949-364-3640
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Fax | 949-364-3630
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY J BYRON
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Credential | DPM
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Telephone | 949-364-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E1816
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License Number State | CA
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