Healthcare Provider Details

I. General information

NPI: 1922149798
Provider Name (Legal Business Name): LISA DYER YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LISA DAWN DYER

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 VILLAGE PROFESSIONAL DRIVE
OPELIKA AL
36801-4702
US

IV. Provider business mailing address

2401 VILLAGE PROFESSIONAL DRIVE
OPELIKA AL
36801-4702
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8121
  • Fax: 334-749-6166
Mailing address:
  • Phone: 334-749-8121
  • Fax: 334-749-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21253
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: