Provider Demographics
NPI:1568499895
Name:DYER, JEAN-FARERE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-FARERE
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARERE
Other - Middle Name:J
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3405 SAINT CLAUDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-6144
Mailing Address - Country:US
Mailing Address - Phone:504-943-9578
Mailing Address - Fax:504-943-9557
Practice Address - Street 1:3405 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-6144
Practice Address - Country:US
Practice Address - Phone:504-943-9578
Practice Address - Fax:504-943-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04539R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306428Medicaid
LA1306428Medicaid
LA5K314Medicare PIN