Basic Information
| Provider Information | |||||||||
| NPI: | 1316289192 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DYER | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1292 HIGH ST STE 224 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415002500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3801 SACRAMENTO ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941181625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156412198 | ||||||||
| FaxNumber: | 4158654189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2013 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA173036 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA56688 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA56688 | 01 | CA | STATE MEDICAL LICENSE | OTHER |