Provider Demographics
NPI:1063457570
Name:DONNA DYER DO INC
Entity Type:Organization
Organization Name:DONNA DYER DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-286-4045
Mailing Address - Street 1:611 SW FEDERAL HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-286-4045
Mailing Address - Fax:772-286-4051
Practice Address - Street 1:611 SW FEDERAL HWY
Practice Address - Street 2:SUITE E
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-286-4045
Practice Address - Fax:772-286-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8635261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0068AMedicare UPIN
FLH29352Medicare ID - Type Unspecified