Provider Demographics
NPI:1699778019
Name:BYRNES, DAVID CARTHAGE JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARTHAGE
Last Name:BYRNES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20065
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0065
Mailing Address - Country:US
Mailing Address - Phone:813-890-8004
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:2810 W SAINT ISABEL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6375
Practice Address - Country:US
Practice Address - Phone:813-890-8004
Practice Address - Fax:813-290-9691
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114343207R00000X
NY138791207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008090500Medicaid
FLP01151446OtherRR MEDICARE
FLME114343OtherLICENSE NO
FLP01151446OtherRR MEDICARE
FLGW191ZMedicare PIN