Healthcare Provider Details

I. General information

NPI: 1588651301
Provider Name (Legal Business Name): JEFFREY J. DYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 E CHAUNCEY LN SUITE 100
PHOENIX AZ
85054-5155
US

IV. Provider business mailing address

6950 E CHAUNCEY LN SUITE 100
PHOENIX AZ
85054-5155
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-3200
  • Fax: 480-538-3210
Mailing address:
  • Phone: 480-538-3200
  • Fax: 480-538-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number26487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: