Healthcare Provider Details

I. General information

NPI: 1932121480
Provider Name (Legal Business Name): JENNIFER S DYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DILLMONT DR SUITE 100
COLUMBUS OH
43235-6458
US

IV. Provider business mailing address

55 DILLMONT DR SUITE 100
COLUMBUS OH
43235-6458
US

V. Phone/Fax

Practice location:
  • Phone: 614-839-3040
  • Fax: 614-839-3041
Mailing address:
  • Phone: 614-839-3040
  • Fax: 614-839-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35088228
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: