Provider Demographics
NPI:1922119650
Name:DYER, RUPERT (DO)
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:420 JOHNSON ST SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1523
Practice Address - Country:US
Practice Address - Phone:229-995-2990
Practice Address - Fax:229-995-2993
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051314207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA887065OtherBCBS - EMC
GA7796360OtherAETNA
GA887063OtherBCBS - EAMC
GA887064OtherBCBS - DMC
GA887064OtherBCBS - DMC
GA887063OtherBCBS - EAMC