Provider Demographics
NPI:1366449969
Name:DWYER, RICHARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
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 1:201 S ALVARADO ST
Mailing Address - Street 2:STE 407
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2353
Mailing Address - Country:US
Mailing Address - Phone:213-483-2470
Mailing Address - Fax:213-483-0476
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:STE 407
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2353
Practice Address - Country:US
Practice Address - Phone:213-483-2470
Practice Address - Fax:213-483-0476
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31641207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C316410Medicaid
MO31679OtherMO MEDICAL DOCTOR LICENSE
CAC31641OtherCA MD LICENSE
CAGR009250Medicaid
CAGR0009251Medicaid
CAGR0009251Medicaid
CAA34654Medicare UPIN
CAW5176FMedicare ID - Type Unspecified
CA00C316410Medicaid
MO31679OtherMO MEDICAL DOCTOR LICENSE