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General NPI Number Information
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NPI Number | 1821084443
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Entity Type | Individual
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Provider Name | BYRON JAMES VAN DYKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1158 N COURT ST
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City | REDDING
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State | CA
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Zip | 96001-0436
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Country | US
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Telephone | 530-247-7546
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Fax | 530-247-7228
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Provider Business Mailing Address
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Address Line | PO BOX 994505
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City | REDDING
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State | CA
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Zip | 96099-4505
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Country | US
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Telephone | 530-247-7546
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Fax | 530-247-7228
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A69012
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License Number State | CA
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