Healthcare Provider Details

I. General information

NPI: 1225013311
Provider Name (Legal Business Name): DONALD ROSS DILLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 AL HIGHWAY 69 MARSHALL COUNTY MEDICAL CENTER NORTH
GUNTERSVILLE AL
35976-7140
US

IV. Provider business mailing address

PO BOX 1547
SEDALIA MO
65302-1547
US

V. Phone/Fax

Practice location:
  • Phone: 256-571-8000
  • Fax:
Mailing address:
  • Phone: 660-826-5960
  • Fax: 660-826-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13066
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: