Individual
BRETT AARON DYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4605 MACCORKLE AVNEUE, SW, SOUTH CHARLESTON, WV 25309
(304) 766-3600
Mailing address
110 ROANE ST, CHARLESTON, WV 25302-2334
(304) 344-0096
(304) 342-4725
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
68352
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
88063
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810023357
—
WV
01
—
Q39833A
MEDICARE PTAN
WV
Enumeration date
05/09/2012
Last updated
09/11/2012
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