Provider Demographics
NPI:1902891906
Name:BYERS, JONATHAN P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:P
Last Name:BYERS
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:608 UNION CHAPEL RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9357
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-373-4000
Practice Address - Fax:260-482-4442
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000568A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN047840WWWMedicare ID - Type Unspecified
INP48081Medicare UPIN
970023451Medicare ID - Type UnspecifiedRR MEDICARE