Healthcare Provider Details

I. General information

NPI: 1538853528
Provider Name (Legal Business Name): NEWMAN CONNOR DYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST # BOXL
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

2530 STRATFORD DR
SAINT JOSEPH MI
49085-2714
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-8300
  • Fax:
Mailing address:
  • Phone: 503-686-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN42784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: