Provider Demographics
NPI:1881659803
Name:DYKERS, JOHN R JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:DYKERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:401A N IVEY AVE
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344
Mailing Address - Country:US
Mailing Address - Phone:919-663-2931
Mailing Address - Fax:919-663-2751
Practice Address - Street 1:401A IVEY AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344
Practice Address - Country:US
Practice Address - Phone:919-663-2931
Practice Address - Fax:919-663-2751
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC11837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929635Medicaid
NC8929635Medicaid
NC201014AMedicare ID - Type Unspecified