Provider Demographics
NPI:1215982541
Name:DRYER, THOMAS ADOLPH (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ADOLPH
Last Name:DRYER
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 1:5151 MORNING SUN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9545
Mailing Address - Country:US
Mailing Address - Phone:513-664-3950
Mailing Address - Fax:513-664-3959
Practice Address - Street 1:5151 MORNING SUN RD
Practice Address - Street 2:SUITE B
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9545
Practice Address - Country:US
Practice Address - Phone:513-664-3950
Practice Address - Fax:513-664-3959
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0506554Medicaid
OH0506554Medicaid
OH4060358Medicare PIN