Provider Demographics
NPI:1407893357
Name:DYER, R SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:SCOTT
Last Name:DYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3300 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2405
Mailing Address - Country:US
Mailing Address - Phone:612-588-9411
Mailing Address - Fax:612-522-6627
Practice Address - Street 1:3300 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2405
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-522-6627
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN23325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95155Medicare UPIN