Provider Demographics
NPI:1619074846
Name:DR H L DYER LUNG SPECIALIST, INC
Entity Type:Organization
Organization Name:DR H L DYER LUNG SPECIALIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-371-0928
Mailing Address - Street 1:11101 WHITESTONE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4632
Mailing Address - Country:US
Mailing Address - Phone:614-371-0928
Mailing Address - Fax:
Practice Address - Street 1:11101 WHITESTONE RANCH RD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-4632
Practice Address - Country:US
Practice Address - Phone:614-371-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004055207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618808Medicaid
OH9347031Medicare PIN