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NPI Code Detail

MEDICARE: CONNOR CORNELIS GEMMELL BYRNE MD

MEDICARE: CONNOR CORNELIS GEMMELL BYRNE MD
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
12085R0202XDiagnostic Radiology Physician2025-03658NC
22085N0700XNeuroradiology Physician176828CA
32085R0202XDiagnostic Radiology PhysicianA176828CA
42085R0202XDiagnostic Radiology Physician036.178492IL

General Provider Information

NPI Number : 1134680499
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR CORNELIS GEMMELL BYRNE MD
Provider Business Mailing Address
First Line : 2825 OAK LAWN AVE UNIT 192749
Second Line :
City : DALLAS
State : TX
Zip : 75219-4688
Country : US
Telephone Number : 510-683-9500
Fax Number : 877-880-2039
Provider Business Practice Location Address
First Line : 2825 OAK LAWN AVE UNIT 192749
Second Line :
City : DALLAS
State : TX
Zip : 75219-4688
Country : US
Telephone Number : 510-683-9500
Fax Number : 877-880-2039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2019
Last Update Date : 01/19/2026

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