Provider Demographics
NPI:1023295946
Name:DWYER, GRACE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ANN
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 NW 168TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6051
Mailing Address - Country:US
Mailing Address - Phone:786-565-9486
Mailing Address - Fax:786-565-9619
Practice Address - Street 1:150 NW 168TH ST STE 305
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6051
Practice Address - Country:US
Practice Address - Phone:787-565-9489
Practice Address - Fax:786-565-9619
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280827700Medicaid