Healthcare Provider Details

I. General information

NPI: 1558328732
Provider Name (Legal Business Name): STEPHEN FEDERICK DYKE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 EVANS ST
NEWBERRY SC
29108-2940
US

IV. Provider business mailing address

2520 EVANS ST
NEWBERRY SC
29108-2940
US

V. Phone/Fax

Practice location:
  • Phone: 803-276-4422
  • Fax: 803-276-1592
Mailing address:
  • Phone: 803-276-4422
  • Fax: 803-276-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number474
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: