Provider Demographics
NPI:1992447270
Name:BYERS, BEATRIZ E (IDC)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:E
Last Name:BYERS
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 ORTEGA PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7800
Mailing Address - Country:US
Mailing Address - Phone:910-915-5474
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVENUE
Practice Address - Street 2:BUILDING 2104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty