Healthcare Provider Details

I. General information

NPI: 1528012226
Provider Name (Legal Business Name): DONNA LYNN DYESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST STE 2N
MOBILE AL
36604-1512
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5763
  • Fax: 251-660-5752
Mailing address:
  • Phone: 251-660-5763
  • Fax: 251-660-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11290
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number11290
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: