Provider Demographics
NPI:1588873137
Name:DWYER, REGINA JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:JOAN
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 EGG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-7049
Mailing Address - Country:US
Mailing Address - Phone:360-378-9608
Mailing Address - Fax:360-378-3708
Practice Address - Street 1:523 EGG LAKE RD
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7049
Practice Address - Country:US
Practice Address - Phone:360-378-9608
Practice Address - Fax:360-378-3708
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00025650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine