Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 04-30808 | KS |
Y | 2086S0102X | Surgical Critical Care | 787 | WI |
NPI | 1063545317 |
---|---|
Provider Name | Dr. Matthew Christopher Byrnes |
First Address | Garden City, KS 67846 |
Second Address | Appleton, WI 54911-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-30808 | KS LICENSE (01) | KS |
200962440A | (05) | KS |