Basic Information
| Provider Information | |||||||||
| NPI: | 1215427018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYER | ||||||||
| FirstName: | DEAUNDRE | ||||||||
| MiddleName: | ALFONZO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 OLD KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | KNIGHTDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275459065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136271710 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 OLD KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | KNIGHTDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275459065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192666211 | ||||||||
| FaxNumber: | 9193509824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2018 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 58.030265 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2020-04561 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.