Individual
MAYNARD C DYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 COOPER ST, FORT WORTH, TX 76104-2710
(682) 885-6299
(682) 885-1090
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
H9069
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U87Z
BCBSTX GRP PIN
TX
01
—
10028696
AMERIGROUP PIN
TX
01
—
109539
SUPERIOR PIN
TX
01
—
112070100
FIRSTCARE PIN
TX
05
—
136186712
—
TX
01
—
136186713
CSHCN
TX
05
—
136186714
—
TX
01
—
136186715
CSHCN
TX
01
—
1392667
UHC PIN
TX
05
—
140442845
—
TX
01
—
1485631
CIGNA PIN
TX
01
—
1640370
FIRSTHEALTH PIN
TX
01
—
386710
GREAT WEST PIN
TX
01
—
413449
PHCS PIN
TX
01
—
4613484
AETNA PIN
TX
01
—
62741133
MULTIPLAN PIN
TX
01
—
89V243
BCBSTX IND PIN
TX
Enumeration date
08/11/2006
Last updated
04/03/2012
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