Provider Demographics
NPI:1720033731
Name:DYER, CARLA ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ALEXANDER
Last Name:DYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-9066
Practice Address - Fax:573-884-3037
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000159829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209026202Medicaid
MO672639OtherHEALTHLINK
MO192782OtherBLUE SHIELD/BLUE CHOICE
MO7500336OtherUNITED HEALTHCARE
MOP00208218OtherRR MEDICARE
MO927035236Medicare PIN
MOP00609878Medicare PIN
MO192782OtherBLUE SHIELD/BLUE CHOICE
I19835Medicare UPIN
MO209026202Medicaid