Provider Demographics
NPI:1275528937
Name:DYE, GREGORY BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRIAN
Last Name:DYE
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 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4823
Mailing Address - Fax:606-633-1874
Practice Address - Street 1:132 VILLAGE CENTER RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1777
Practice Address - Country:US
Practice Address - Phone:606-573-7771
Practice Address - Fax:606-573-2809
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-03-10
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
KY36164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64036452Medicaid
KY64036452Medicaid
KY0919924Medicare PIN