Healthcare Provider Details

I. General information

NPI: 1952408346
Provider Name (Legal Business Name): GERALD A DYSERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WILLOW DR
AUXIER KY
41602-9259
US

IV. Provider business mailing address

1709 KY ROUTE 321 SUITE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8997
  • Fax: 606-886-1021
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: