Provider Demographics
NPI:1669769915
Name:FRANCES DWYER, MD
Entity type:Organization
Organization Name:FRANCES DWYER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-675-9630
Mailing Address - Street 1:1712 LINCOLNWAY W
Mailing Address - Street 2:SUITE A
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-1933
Mailing Address - Country:US
Mailing Address - Phone:574-675-9630
Mailing Address - Fax:574-675-9629
Practice Address - Street 1:1712 LINCOLNWAY W
Practice Address - Street 2:SUITE A
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-1933
Practice Address - Country:US
Practice Address - Phone:574-675-9630
Practice Address - Fax:574-675-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030061A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201031910AMedicaid