Provider Demographics
NPI:1578931721
Name:DYER, JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3546 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:108
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2713
Mailing Address - Country:US
Mailing Address - Phone:904-374-3672
Mailing Address - Fax:904-813-7156
Practice Address - Street 1:3546 SAINT JOHNS BLUFF RD S
Practice Address - Street 2:108
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2713
Practice Address - Country:US
Practice Address - Phone:904-374-3672
Practice Address - Fax:904-813-7156
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9108928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant