Provider Demographics
NPI:1851364707
Name:DYER, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:S69W15636 JANESVILLE RD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9330
Practice Address - Country:US
Practice Address - Phone:262-928-7000
Practice Address - Fax:414-422-2075
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI38231208000000X
AZ14574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32268900Medicaid
WI000768004Medicare PIN
WID36788Medicare UPIN
WI683750694Medicare PIN