Healthcare Provider Details

I. General information

NPI: 1063457570
Provider Name (Legal Business Name): DONNA DYER DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SW FEDERAL HWY SUITE E
STUART FL
34994-2925
US

IV. Provider business mailing address

611 SW FEDERAL HWY SUITE E
STUART FL
34994-2925
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-4045
  • Fax: 772-286-4051
Mailing address:
  • Phone: 772-286-4045
  • Fax: 772-286-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOS8635
License Number StateFL

VIII. Authorized Official

Name: DR. DONNA DYER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 772-286-4045