Healthcare Provider Details

I. General information

NPI: 1881659803
Provider Name (Legal Business Name): JOHN R DYKERS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401A IVEY AVE
SILER CITY NC
27344
US

IV. Provider business mailing address

PO BOX 565 401A N IVEY AVE
SILER CITY NC
27344
US

V. Phone/Fax

Practice location:
  • Phone: 919-663-2931
  • Fax: 919-663-2751
Mailing address:
  • Phone: 919-663-2931
  • Fax: 919-663-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: