Provider Demographics
NPI:1518968221
Name:DWYER, FRANCES DOYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:DOYLE
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 HICKORY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1933
Mailing Address - Country:US
Mailing Address - Phone:574-251-0498
Mailing Address - Fax:574-251-0068
Practice Address - Street 1:3212 HICKORY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1933
Practice Address - Country:US
Practice Address - Phone:574-251-0498
Practice Address - Fax:574-251-0068
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030061A2080A0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000363470OtherBCBS
IN100222820AMedicaid
IN000000363470OtherBCBS