Provider Demographics
NPI:1740285287
Name:DYKE, VALERIE R (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:R
Last Name:DYKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:13770 PLANTATION RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4301
Practice Address - Country:US
Practice Address - Phone:239-275-0728
Practice Address - Fax:239-275-6947
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078379208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46777OtherBCBS PROVIDER NUMBER
FLP00337577OtherRAILROAD MEDICARE #
FL257226500Medicaid
FL14-00162OtherUHC PROVIDER NUMBER
FL7745035OtherAETNA OTHER PROVIDER #
FLME78378OtherMETCARE PROVIDER NUMBER
FL07738OtherUNIV. HLTHCR. PROVIDER #
FL277499OtherAVMED
FL780836OtherWELLCAE
FL1794498-002OtherCIGNA PROVIDER NUMBER
FL3739673OtherAETNA HMO PROVIDER #
FL7745035OtherAETNA OTHER PROVIDER #
FL14-00162OtherUHC PROVIDER NUMBER