1528348521 NPI number — ROBERT K DYER MD DERMATOLOGY LLC

Table of content: DR. JOHN T. FUNAI M.D. (NPI 1710082912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528348521 NPI number — ROBERT K DYER MD DERMATOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT K DYER MD DERMATOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528348521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3461 S COUNTY TRL
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
EAST GREENWICH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02818-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-471-3376
Provider Business Mailing Address Fax Number:
401-471-6865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3461 S COUNTY TRL
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-471-3376
Provider Business Practice Location Address Fax Number:
401-471-6865
Provider Enumeration Date:
08/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DYER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-330-9588

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)