Healthcare Provider Details

I. General information

NPI: 1740820034
Provider Name (Legal Business Name): GREGORY DAVISON DYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FRANKLIN ST
SAN FRANCISCO CA
94109-4523
US

IV. Provider business mailing address

125 PRECITA AVE
SAN FRANCISCO CA
94110-4620
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112862
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number112862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: