Everett Brantley Dyer, M.D
Individual provider Active NPI Pediatrics Physician · Cameron Park, CA
NPI 1184654030 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1184654030
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- G65725 (CA)
- Practice address
- 3427 Robin LN
Suite 100
Cameron Park, CA 95682-7254 - Phone
- (530) 676-7337
- Fax
- (530) 676-6644
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65725 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cameron Park Medical Group | Pediatrics | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G65725 | CA | Yes |
Addresses
Primary practice location
3427 Robin LN
Suite 100
Cameron Park, CA 95682-7254
Mailing address
3400 Data Dr
Physician Support Services
Rancho Cordova, CA 95670-7956
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G657250 | Other | CA | LICENSE # |
Other providers in Cameron Park, CA
- Fengying Deng
- Dignity Health Medical Foundation
- Discovery Psychotherapy Center, Inc.
- DNT in Home Care, Inc
- Dr. Lauren Anderson .OD., Inc.
- Wendy Zilch Dyer
- David W. Egbert
- El Dorado County Community Health Center
- El Dorado County Community Health Center
- El Dorado County Community Health Center
All providers in Cameron Park, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.