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General NPI Number Information
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NPI Number | 1063457570
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Entity Type | Organization
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Legal Business Name | DONNA DYER DO INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 611 SW FEDERAL HWY SUITE E
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-286-4045
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Fax | 772-286-4051
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Provider Business Mailing Address
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Address Line | 611 SW FEDERAL HWY SUITE E
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-286-4045
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Fax | 772-286-4051
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONNA DYER
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Credential | D.O.
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Telephone | 772-286-4045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | OS8635
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License Number State | FL
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