Healthcare Provider Details

I. General information

NPI: 1538456561
Provider Name (Legal Business Name): CHRISTOPHER RYAN DWYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MAYFIELD RD STE 250
ARLINGTON TX
76014-2084
US

IV. Provider business mailing address

11551 FOREST CENTRAL DR STE 133
DALLAS TX
75243-3915
US

V. Phone/Fax

Practice location:
  • Phone: 682-217-2102
  • Fax:
Mailing address:
  • Phone: 214-343-8565
  • Fax: 214-342-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberR2582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: