MEDICARE: BARBARA PETRANELLA DYER MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1700636511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA PETRANELLA DYER MD

Provider Business Mailing Address
First Line	:	2603 MULBERRY ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2644
Country	:	US
Telephone Number	:	816-294-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 MULBERRY ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2644
Country	:	US
Telephone Number	:	816-294-1988
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	04/15/2024

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