Provider Demographics
NPI:1740273515
Name:DYER, JAY (CRNA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:CRNA
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 567
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-0567
Mailing Address - Country:US
Mailing Address - Phone:216-464-5160
Mailing Address - Fax:216-464-5982
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:GEAUGA HOSPITAL
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-285-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH247880367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000515990OtherANTHEM
OH414966OtherWELLCARE MEDICAID
OH000000221227OtherUNISON
OHP00416766OtherMEDICARE RAILROAD
OH2380589Medicaid
OH730548OtherBUCKEYE MEDICAID
OH7008730OtherAETNA
OH2380589Medicaid
OH000000221227OtherUNISON
OH414966OtherWELLCARE MEDICAID