Provider Demographics
NPI:1972819787
Name:DYER, DONALD D
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:DYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COUNTY ROAD 1276
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-6202
Mailing Address - Country:US
Mailing Address - Phone:256-739-1233
Mailing Address - Fax:256-734-5129
Practice Address - Street 1:65 COUNTY ROAD 1276
Practice Address - Street 2:
Practice Address - City:VINEMONT
Practice Address - State:AL
Practice Address - Zip Code:35179-6202
Practice Address - Country:US
Practice Address - Phone:256-739-1233
Practice Address - Fax:256-734-5129
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL244252471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000032914Medicaid
051532914Medicare PIN