=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750354569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY CARLISLE DWYER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2006
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6000 W HIGHWAY 98
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32512-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-505-6261
-----------------------------------------------------
Fax | 850-505-6548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 W HIGHWAY 98
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32512-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-505-6261
-----------------------------------------------------
Fax | 850-505-6548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 16578
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------