Provider Demographics
NPI:1871581744
Name:DYAL, LARRY B JR (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:B
Last Name:DYAL
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3774
Mailing Address - Country:US
Mailing Address - Phone:912-265-0709
Mailing Address - Fax:912-574-5953
Practice Address - Street 1:10 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3774
Practice Address - Country:US
Practice Address - Phone:912-265-0709
Practice Address - Fax:912-574-5953
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA400885615DMedicaid
GAU99913Medicare UPIN
GA400885615DMedicaid