Provider Demographics
NPI:1396944245
Name:DYBALL, PAUL STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:DYBALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-672-6336
Practice Address - Fax:231-672-6335
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017457204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN275300072Medicare PIN