MEDICARE: DR. KEVIN GERARD BYRNE D.O.

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	207RG0100X	Gastroenterology Physician	DO107693	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110198631	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326020082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN GERARD BYRNE D.O.

Provider Business Mailing Address
First Line	:	1029 NICHOLS RD STE 201
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3008
Country	:	US
Telephone Number	:	573-302-7138
Fax Number	:	573-302-7123

Provider Business Practice Location Address
First Line	:	1029 NICHOLS RD STE 201
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3008
Country	:	US
Telephone Number	:	573-302-7138
Fax Number	:	573-302-7123

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. KEVIN GERARD BYRNE D.O.” Practice Location

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