Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME116486 | FL |
N | 2080A0000X | Adolescent Medicine | ME116486 | FL |
NPI | 1033438502 |
---|---|
Provider Name | Mrs. Katherine M Byra |
First Address | Jacksonville, FL 32258-5212 |
Second Address | Jacksonville, FL 32258-5212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010556400 | (05) | FL |