Provider Demographics
NPI:1548203433
Name:DYER, CHRISTOPHER WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WAYNE
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 1:927 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2127
Mailing Address - Country:US
Mailing Address - Phone:972-668-7460
Mailing Address - Fax:
Practice Address - Street 1:928 LIPSCOMB ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3171
Practice Address - Country:US
Practice Address - Phone:817-348-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3629207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022NGOtherBCBS
TXH62516Medicare UPIN
TX612567Medicare PIN