MEDICARE: ROBERT BYRNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R1J78	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	0403000	OTHER		UHC MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0400915	OTHER	MO	UHC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11011	OTHER	MO	BCBS
4	5241272	OTHER	MO	AETNA
5	B18388	OTHER	MO	MERCY
6	000000010010	OTHER	MO	ESSENCE
7	000000012459	OTHER	MO	ESSENCE ST CHARLES
8	127465	OTHER		GHP
9	D04003	OTHER	MO	EXCLUSIVE CHOICE
11	165438	OTHER		HEALTHLINK
12	165438	OTHER	MO	HEALTHLINK

General Provider Information

NPI Number	:	1124009022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BYRNE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	314-739-4166
Fax Number	:	314-739-2485

Provider Business Practice Location Address
First Line	:	12255 DE PAUL DR
Second Line	:	SUITE 700
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2510
Country	:	US
Telephone Number	:	314-739-4166
Fax Number	:	314-739-2485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	09/21/2012

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Directions to “ ROBERT BYRNE M.D.” Practice Location

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