Provider Demographics
NPI:1962411272
Name:BYRNE, MARK GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GERARD
Last Name:BYRNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30 BRENNAN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4303
Mailing Address - Country:US
Mailing Address - Phone:831-768-0220
Mailing Address - Fax:831-722-1702
Practice Address - Street 1:30 BRENNAN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4303
Practice Address - Country:US
Practice Address - Phone:831-768-0220
Practice Address - Fax:831-722-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74388207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G743880Medicaid
CAF49627Medicare UPIN
CA00G743880Medicaid