Provider Demographics
NPI:1346005543
Name:DYER, LARRY DAVID (HIS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DAVID
Last Name:DYER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 N MAIN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1451
Mailing Address - Country:US
Mailing Address - Phone:417-926-1409
Mailing Address - Fax:
Practice Address - Street 1:2130 N MAIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1451
Practice Address - Country:US
Practice Address - Phone:417-926-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014834237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist