Provider Demographics
NPI:1194855528
Name:DREYER, PAUL T (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:DREYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-261-3869
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 537N
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-894-4693
Practice Address - Fax:407-896-0569
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116056207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086901Medicaid
IL390005526OtherBCBS
IL390005526OtherRAILROAD MEDICARE
IL036086901Medicaid
ILF60871Medicare UPIN
IL390005526OtherBCBS