MEDICARE: ELIZABETH DYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A70406	CA

General Provider Information

NPI Number	:	1770607186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DYER MD

Provider Business Mailing Address
First Line	:	24502 PACIFIC PARK DR STE 104
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3033
Country	:	US
Telephone Number	:	949-898-6220
Fax Number	:	949-898-6221

Provider Business Practice Location Address
First Line	:	24502 PACIFIC PARK DR STE 104
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3033
Country	:	US
Telephone Number	:	949-898-6220
Fax Number	:	949-898-6221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/06/2024

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