Healthcare Provider Details

I. General information

NPI: 1972666964
Provider Name (Legal Business Name): JAMES R DYREBY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E TIMBER DR
RHINELANDER WI
54501-2852
US

IV. Provider business mailing address

444 E TIMBER DR
RHINELANDER WI
54501-2852
US

V. Phone/Fax

Practice location:
  • Phone: 715-369-2300
  • Fax:
Mailing address:
  • Phone: 715-369-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22255
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: