Provider Demographics
NPI:1780806505
Name:DYER-SMITH, JEFFERY (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:DYER-SMITH
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:5336 STADIUM TRACE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4580
Practice Address - Country:US
Practice Address - Phone:205-795-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27557207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147595Medicaid
AL147568Medicaid
P01200306Medicare PIN
102I053885Medicare PIN
102I052964Medicare PIN
AL147568Medicaid