Provider Demographics
NPI:1205050267
Name:DYER, PHILIP DENNIS (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:DENNIS
Last Name:DYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 NORTHLAND DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4945
Mailing Address - Country:US
Mailing Address - Phone:512-458-9191
Mailing Address - Fax:
Practice Address - Street 1:3303 NORTHLAND DR
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4945
Practice Address - Country:US
Practice Address - Phone:512-458-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N24TOtherBCBS ATX GROUP
TX84430SOtherBCBS AUSTIN,TX
TX0032HSOtherBCBS RR,TX
TX030005345OtherRAILROAD MCARE
TX8F6356OtherBCBS RR,TX GROUP
TX00N24TOtherBCBS ATX GROUP
TX8618B6Medicare ID - Type UnspecifiedMCARE RR,TX GROUP
TX00656TMedicare ID - Type UnspecifiedMCARE ROUND ROCK TX
TXG37414Medicare UPIN
TX8F6356OtherBCBS RR,TX GROUP