Provider Demographics
NPI:1841626678
Name:DYER, EVAN PATRICK (PA-C)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:PATRICK
Last Name:DYER
Suffix:
Gender:M
Credentials:PA-C
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 1258
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-1258
Mailing Address - Country:US
Mailing Address - Phone:931-253-1110
Mailing Address - Fax:256-664-4280
Practice Address - Street 1:1415 HILLSBORO BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2599
Practice Address - Country:US
Practice Address - Phone:931-954-5605
Practice Address - Fax:931-954-5606
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2418363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical