Provider Demographics
NPI:1356458699
Name:DWYER, JAMES GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GERARD
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 1:1848 E THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8103
Mailing Address - Country:US
Mailing Address - Phone:602-456-2342
Mailing Address - Fax:602-688-2342
Practice Address - Street 1:1848 E THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8103
Practice Address - Country:US
Practice Address - Phone:602-456-2342
Practice Address - Fax:602-688-2342
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28611207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ532483Medicaid
AZ532483Medicaid
AD8709416OtherDEA
AZA13477Medicare UPIN