Provider Demographics
NPI:1548286487
Name:BYRD, JUNE VAUGHN (LM,CPM)
Entity type:Individual
Prefix:MS
First Name:JUNE
Middle Name:VAUGHN
Last Name:BYRD
Suffix:
Gender:F
Credentials:LM,CPM
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 2073
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616-2073
Mailing Address - Country:US
Mailing Address - Phone:352-514-1182
Mailing Address - Fax:386-462-7230
Practice Address - Street 1:13219 NW 140TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6109
Practice Address - Country:US
Practice Address - Phone:352-514-1182
Practice Address - Fax:386-462-7230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLM148176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340277100Medicaid
FLY008DOtherBLUE CROSS BLUE SHIELD