Healthcare Provider Details

I. General information

NPI: 1962456376
Provider Name (Legal Business Name): DONALD A DYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19369 E QUINCY PL
AURORA CO
80015-2826
US

IV. Provider business mailing address

19369 E QUINCY PL
AURORA CO
80015-2826
US

V. Phone/Fax

Practice location:
  • Phone: 208-221-7460
  • Fax:
Mailing address:
  • Phone: 208-221-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM-3457
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: