Provider Demographics
NPI:1326031014
Name:DYKES, HERMAN WESLEY JR (DO)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:WESLEY
Last Name:DYKES
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MDG
Mailing Address - Street 2:UNIT 3215
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 MDG
Practice Address - Street 2:UNIT 32115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:314-480-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
FLOS10357207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50487OtherBLUECROSS BLUESHIELD
FLP00779273OtherMEDICARE RAILROAD
FL7351464OtherAETNA
FL319161OtherAVMED
FL281247900Medicaid
FL3602151OtherCIGNA
FL3602151OtherCIGNA
FL281247900Medicaid