Provider Demographics
NPI:1235151440
Name:DYER, CURTIS W (MD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:W
Last Name:DYER
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:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1027
Mailing Address - Country:US
Mailing Address - Phone:573-681-3767
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:140 NORTHSTAR DR
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1123
Practice Address - Country:US
Practice Address - Phone:573-896-8301
Practice Address - Fax:573-896-8589
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991150OtherANTHEM BCBS
MO10893815OtherCAQH
MOC51866Medicare UPIN
MO151900010Medicare PIN
MOT145072Medicare ID - Type UnspecifiedMEDICARE