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General NPI Number Information
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NPI Number | 1023295946
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Entity Type | Individual
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Provider Name | GRACE ANN DWYER M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 150 NW 168TH ST STE 305
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6051
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Country | US
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Telephone | 787-565-9489
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Fax | 786-565-9619
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Provider Business Mailing Address
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Address Line | 150 NW 168TH ST STE 305
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6051
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Country | US
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Telephone | 786-565-9486
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Fax | 786-565-9619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME77284
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License Number State | FL
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