Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2018007739 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2018007739 | MO |
NPI | 1336535145 |
---|---|
Provider Name | Dr. Chadwick Byle |
First Address | Blue Springs, MO 64014-5493 |
Second Address | Blue Springs, MO 64014-5493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 03/02/2020 |