Healthcare Provider Details

I. General information

NPI: 1366449969
Provider Name (Legal Business Name): RICHARD MICHAEL DWYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO ST STE 407
LOS ANGELES CA
90057-2353
US

IV. Provider business mailing address

201 S ALVARADO ST STE 407
LOS ANGELES CA
90057-2353
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-2470
  • Fax: 213-483-0476
Mailing address:
  • Phone: 213-483-2470
  • Fax: 213-483-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC31641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: