Dyer, Jack W.

Dyer, Jack W. is an individual health care provider with primary practice located at 3601 4Th St , Lubbock TX 79430-0002. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dyer, Jack W. can be contacted via phone (806) 743-2757.

Contact Information

Primary practice address
3601 4Th St Lubbock TX 79430-0002
Phone: (806) 743-2757
Fax: (806) 743-2563
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X H8016 Texas

Profile Details

NPI number 1730171802
LBN Legal business name Dyer, Jack W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jan 10th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730171802 NPPES
Oklahoma MEDICAID 100161030A
Oklahoma Other 74368
Oklahoma MEDICAID 136022402
Oklahoma MEDICAID 74368
Oklahoma Other A023
Oklahoma Other 112060100
Oklahoma MEDICAID 136022404
Oklahoma Other 80744Z
Oklahoma Other 89C629
Oklahoma MEDICAID V4111
Oklahoma MEDICAID 112060100

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