Provider Demographics
NPI:1508807751
Name:DYER, SCOTT ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:DYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8160
Mailing Address - Country:US
Mailing Address - Phone:207-622-8660
Mailing Address - Fax:207-622-8661
Practice Address - Street 1:35 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-622-8660
Practice Address - Fax:207-622-8661
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO126145207K00000X, 207KA0200X
WAOP60094489207K00000X, 207KA0200X
MEDO2213207K00000X
ME2213207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1508807751Medicaid
ME002189301Medicare PIN
H71129Medicare UPIN