Provider Demographics
NPI:1235369497
Name:DYER, JONNA M (MD)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:M
Last Name:DYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JONNA
Other - Middle Name:M
Other - Last Name:DYER-GRIFFITHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12 EAST APPLEBY ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-463-7102
Mailing Address - Fax:479-463-7864
Practice Address - Street 1:3215 N. NORTH HILLS BLVD.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4424
Practice Address - Country:US
Practice Address - Phone:479-463-7102
Practice Address - Fax:479-463-7864
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009022185208M00000X
KS04-33974208M00000X
ARE-8220208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200628180AMedicaid
MO1235369497Medicaid
KS200628180AMedicaid
KSE1100000BMedicare PIN