Provider Demographics
NPI:1568467124
Name:DYER, CHAD E (CRNA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:DYER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SUMMERWIND LN
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8861
Mailing Address - Country:US
Mailing Address - Phone:614-586-3311
Mailing Address - Fax:
Practice Address - Street 1:7277 SMITHS MILL RD
Practice Address - Street 2:STE 370
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8195
Practice Address - Country:US
Practice Address - Phone:614-939-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164897367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73307564Medicaid
516908Medicare ID - Type Unspecified
CO73307564Medicaid