Healthcare Provider Details

I. General information

NPI: 1679551212
Provider Name (Legal Business Name): JAMES T DWYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/29/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STATE HWY RTE 6
WELLFLEET MA
02667-7402
US

IV. Provider business mailing address

PO BOX 598
HARWICH PORT MA
02646-0598
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-3131
  • Fax: 508-487-6298
Mailing address:
  • Phone: 508-905-2800
  • Fax: 508-240-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number290887
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: