Healthcare Provider Details

I. General information

NPI: 1356458699
Provider Name (Legal Business Name): JAMES GERARD DWYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 E THOMAS RD STE 100
PHOENIX AZ
85016-8103
US

IV. Provider business mailing address

1848 E THOMAS RD STE 100
PHOENIX AZ
85016-8103
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-2342
  • Fax: 602-688-2342
Mailing address:
  • Phone: 602-456-2342
  • Fax: 602-688-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28611
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number28611
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: