Provider Demographics
NPI:1356315345
Name:DWYER, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:DWYER
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 2184
Mailing Address - Street 2:CERTIFIED EMERGENCY MEDICINE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-2184
Mailing Address - Country:US
Mailing Address - Phone:616-363-7867
Mailing Address - Fax:616-363-9432
Practice Address - Street 1:5900 BYRON CENTER AVE
Practice Address - Street 2:METRO HEALTH HOSPITAL
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-363-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPD058917207PE0004X
TXP7429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3062437Medicaid
TX327124YKN5Medicaid
MI930015754OtherRAILROAD MEDICARE
TX327613101Medicaid
MIF61992Medicare UPIN