Provider Demographics
NPI:1649215260
Name:DYER, JEFFREY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:DYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 N. OAK TRAFFICWAY, LL1
Mailing Address - Street 2:LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-8582
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:5400 N OAK TRFY STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4690
Practice Address - Country:US
Practice Address - Phone:816-453-0900
Practice Address - Fax:816-453-3895
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85883207Q00000X
MO2019046565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85883OtherCA MED LIC
CAW13268AMedicare PIN
CACT091ZMedicare PIN
CAG85883OtherCA MED LIC
CAW13268Medicare PIN
CAW21724Medicare PIN
CABG850Medicare PIN