Provider Demographics
NPI:1093958878
Name:DYCK, RAYNA MARSHA (MD)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:MARSHA
Last Name:DYCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4104
Mailing Address - Country:US
Mailing Address - Phone:205-871-7332
Mailing Address - Fax:205-871-7336
Practice Address - Street 1:1920 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4104
Practice Address - Country:US
Practice Address - Phone:205-871-7332
Practice Address - Fax:205-871-7336
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1669989OtherCIGNA HEALTHSPRINGS
AL51158160OtherBCBS
AL00030002140OtherUNITED HEALTHCARE
AL102I072955OtherMEDICARE