Provider Demographics
NPI:1013969617
Name:DYER, DALE E (FNP)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:E
Last Name:DYER
Suffix:
Gender:M
Credentials:FNP
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 883
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-0883
Mailing Address - Country:US
Mailing Address - Phone:254-729-8033
Mailing Address - Fax:
Practice Address - Street 1:625 MCCLINTIC DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2135
Practice Address - Country:US
Practice Address - Phone:254-729-3411
Practice Address - Fax:254-729-3258
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659987363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8673B2Medicare ID - Type Unspecified