Provider Demographics
NPI:1467468041
Name:DYER, ERIC W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:W
Last Name:DYER
Suffix:
Gender:M
Credentials:PA-C
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 63384
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3384
Mailing Address - Country:US
Mailing Address - Phone:910-457-4789
Mailing Address - Fax:910-457-5824
Practice Address - Street 1:902 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3038
Practice Address - Country:US
Practice Address - Phone:910-457-4789
Practice Address - Fax:910-457-5824
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC9691AMedicare PIN
NCQ64330Medicare UPIN