Individual
TIMOTHY GEORGE DYSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5300 MILITARY RD, LEWISTON, NY 14092-1903
(716) 298-2356
Mailing address
PO BOX 8000 DEPT 570, BUFFALO, NY 14267-0002
(716) 298-2356
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
174697-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01210604
—
NY
Enumeration date
11/14/2005
Last updated
09/16/2021
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