Provider Demographics
NPI:1548697485
Name:DYE, JOHN JR (IDMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:DYE
Suffix:JR
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL AID STATION
Mailing Address - Street 2:UNIT 7710
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65TH ABG/SGO MEDICAL AID STATION
Practice Address - Street 2:UNIT 7710
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09720
Practice Address - Country:US
Practice Address - Phone:314-535-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1003X
15486974851710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians