MEDICARE: JERROLD DREYER, M.D., INC.

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	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922339175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERROLD DREYER, M.D., INC.

Provider Business Mailing Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 105
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-784-3615
Fax Number	:	818-905-0130

Provider Business Practice Location Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 105
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-784-3615
Fax Number	:	818-905-0130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERROLD DREYER
Credential	:	M.D.
Telephone Number	:	818-784-3615

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	02/24/2010

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