Provider Demographics
NPI:1366456394
Name:DYER, KEITH ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ELLIOTT
Last Name:DYER
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 51199
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1199
Mailing Address - Country:US
Mailing Address - Phone:806-416-1041
Mailing Address - Fax:806-418-4329
Practice Address - Street 1:7200 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1703
Practice Address - Country:US
Practice Address - Phone:806-416-1041
Practice Address - Fax:806-418-4329
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5914208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
112061103OtherFIRSTCARE PROV NUMBER
TX8G3990OtherBC/BS INDIVIDUAL NUMBER
112061103OtherSOUTHWEST LIFE INSURANCE
TX0052HZOtherBC/BS GROUP NUMBER
TX8G3990OtherBC/BS INDIVIDUAL NUMBER
112061103OtherSOUTHWEST LIFE INSURANCE
G09864Medicare UPIN
00919TMedicare ID - Type UnspecifiedGROUP PROV NUMBER
P00195675Medicare ID - Type UnspecifiedPALMETTO GBA INDIVIDUAL
TXTXB155858Medicare PIN