Healthcare Provider Details

I. General information

NPI: 1376708339
Provider Name (Legal Business Name): DAVID A DY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MEDICAL GROUP UNIT 7095, BOX 185, BLDG 865
APO AE
09824
US

IV. Provider business mailing address

PSC 94 BOX 2582
APO AE
09824-0026
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-6820
  • Fax:
Mailing address:
  • Phone: 314-676-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: