MEDICARE: MRS. ALLISON GABRIELSON DYE PA-C

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	363AM0700X	Medical Physician Assistant	PA-963	AL

General Provider Information

NPI Number	:	1992122667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON GABRIELSON DYE PA-C

Provider Business Mailing Address
First Line	:	1891 HONEYSUCKLE RD
Second Line	:	SUITE 2
City	:	DOTHAN
State	:	AL
Zip	:	36305-4290
Country	:	US
Telephone Number	:	334-794-6504
Fax Number	:	334-793-4452

Provider Business Practice Location Address
First Line	:	1891 HONEYSUCKLE RD
Second Line	:	SUITE 2
City	:	DOTHAN
State	:	AL
Zip	:	36305-4290
Country	:	US
Telephone Number	:	334-794-6504
Fax Number	:	334-793-4452

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	05/03/2021

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