Provider Demographics
NPI:1730572199
Name:PUNCH, BYRON
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:PUNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 HUNTERS RUN CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-4157
Mailing Address - Country:US
Mailing Address - Phone:214-632-0547
Mailing Address - Fax:
Practice Address - Street 1:7465 HUNTERS RUN CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-4157
Practice Address - Country:US
Practice Address - Phone:214-632-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty