Individual
BRADLEY R DYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5325 FARAON ST, MS 1020 DIVISION OF GENERAL AND GERIATRIC MEDICINE UNIV, SAINT JOSEPH, MO 64506-3488
(816) 271-6406
Mailing address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6406
(816) 271-7986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015000100
MO
208M00000X
Hospitalist Physician
05-35676
KS
208M00000X
Hospitalist Physician
Primary
2015000100
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023214509
—
MO
05
—
200865660C
—
KS
01
—
P01434619
RR MEDICARE
MO
Enumeration date
06/22/2007
Last updated
10/19/2017
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