Individual
DR. DERRY DEAN DYE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 PHYSICIANS PARK STE 400, POPLAR BLUFF, MO 63901-3923
(573) 727-5500
(573) 727-5599
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-5583
(573) 331-5079
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R5G11
MO
208D00000X
General Practice Physician
R5G11
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202400024
—
MO
Enumeration date
08/13/2006
Last updated
02/09/2023
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