Healthcare Provider Details

I. General information

NPI: 1972819787
Provider Name (Legal Business Name): DONALD D DYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COUNTY ROAD 1276
VINEMONT AL
35179-6202
US

IV. Provider business mailing address

65 COUNTY ROAD 1276
VINEMONT AL
35179-6202
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-1233
  • Fax: 256-734-5129
Mailing address:
  • Phone: 256-739-1233
  • Fax: 256-734-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number24425
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: