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General NPI Number Information
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NPI Number | 1538110630
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Entity Type | Individual
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Provider Name | GREGORY ALLEN DWYER MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE SUITE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-664-4161
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Fax | 501-664-6108
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE SUITE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-664-4161
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Fax | 501-664-6108
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | R2753
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License Number State | AR
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