MEDICARE: JOHN GERALD 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	R5094	TX

General Provider Information

NPI Number	:	1952498073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GERALD BYRNE MD

Provider Business Mailing Address
First Line	:	450 W MEDICAL CENTER BLVD STE 600
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 W MEDICAL CENTER BLVD STE 600
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4233
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/13/2021

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