Healthcare Provider Details

I. General information

NPI: 1851364707
Provider Name (Legal Business Name): JOHN E. DYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S69W15636 JANESVILLE RD PROHEALTH CARE MEDICAL ASSOCIATES INC
MUSKEGO WI
53150-9330
US

IV. Provider business mailing address

N17 W24100 RIVERWOOD DRIVE SUITE 250 PROHEALTH CARE MEDICAL ASSOCIATES INC.
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7000
  • Fax: 414-422-2075
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38231
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: