Provider Demographics
NPI:1053610923
Name:STAPLETON, BYRON LAYNE (DO)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:LAYNE
Last Name:STAPLETON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3266
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3266
Mailing Address - Country:US
Mailing Address - Phone:904-819-4602
Mailing Address - Fax:904-819-4426
Practice Address - Street 1:300 HEALTH PARK BLVD STE 5002
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-819-5861
Practice Address - Fax:904-819-5862
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.012166208600000X
FLOS16229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery