Provider Demographics
NPI:1144409749
Name:DWYER, JAMES EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:DWYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WINTER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3302
Mailing Address - Country:US
Mailing Address - Phone:781-335-8811
Mailing Address - Fax:781-335-8882
Practice Address - Street 1:210 WINTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3302
Practice Address - Country:US
Practice Address - Phone:781-335-8811
Practice Address - Fax:781-335-8882
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1830213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361887Medicaid
MA0361887Medicaid
MAY70841Medicare PIN