Healthcare Provider Details

I. General information

NPI: 1649239443
Provider Name (Legal Business Name): ALLEN R DYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC BLDG 52 LAKE ST.
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN CITY TN
37683-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-8000
  • Fax: 423-439-2200
Mailing address:
  • Phone: 423-433-6000
  • Fax: 423-433-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23813
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: