Individual
MWATA O DYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 NICOLLS RD, HSC L4 RM 060, STONY BROOK, NY 11794-0001
(631) 444-2975
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-2975
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
33153
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
882771
—
AZ
Enumeration date
05/28/2006
Last updated
12/10/2008
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