Healthcare Provider Details

I. General information

NPI: 1235151440
Provider Name (Legal Business Name): CURTIS W DYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTHSTAR DR
HOLTS SUMMIT MO
65043-1123
US

IV. Provider business mailing address

PO BOX 1027
JEFFERSON CITY MO
65102-1027
US

V. Phone/Fax

Practice location:
  • Phone: 573-896-8301
  • Fax: 573-896-8589
Mailing address:
  • Phone: 573-681-3767
  • Fax: 573-761-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: