MEDICARE: JON DYER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649016106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON DYER

Provider Business Mailing Address
First Line	:	1717 W COWLES ST
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99701-5926
Country	:	US
Telephone Number	:	907-452-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 55
Second Line	:
City	:	MANLEY HOT SPRINGS
State	:	AK
Zip	:	99756-0055
Country	:	US
Telephone Number	:	800-478-6682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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Directions to “ JON DYER ” Practice Location

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