Healthcare Provider Details

I. General information

NPI: 1013969617
Provider Name (Legal Business Name): DALE E. DYER F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MCCLINTIC DR
GROESBECK TX
76642-2135
US

IV. Provider business mailing address

PO BOX 883
GROESBECK TX
76642-0883
US

V. Phone/Fax

Practice location:
  • Phone: 254-729-3411
  • Fax: 254-729-3258
Mailing address:
  • Phone: 254-729-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number659987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: