Basic Information
Provider Information
NPI: 1326096025
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYERS
FirstName: GEORGE
MiddleName: E
NamePrefix: DR.
NameSuffix: III
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 E ROLLINS ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031248
CountryCode: US
TelephoneNumber: 3523319729
FaxNumber: 3523310136
Practice Location
Address1: 601 E ROLLINS ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031248
CountryCode: US
TelephoneNumber: 4072002355
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/04/2006
LastUpdateDate: 01/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XME63050FLY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
27085501FLAVMEDOTHER
P0031672401FLRAIL ROAD MEDICAREOTHER
23921601FLAVMEDOTHER
37561140005FL MEDICAID
P0032391801FLRAIL ROAD MEDICAREOTHER
2537401FLBCBSFLOTHER


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