Provider Demographics
NPI:1376787937
Name:DYER, ALISHA R (DO)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:R
Last Name:DYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:R
Other - Last Name:MCCON-DYER-REPLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD-REPLACE
Mailing Address - Street 1:8170 LAGUNA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7901
Mailing Address - Country:US
Mailing Address - Phone:916-691-5900
Mailing Address - Fax:916-691-6747
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-451-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A11439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program