Healthcare Provider Details

I. General information

NPI: 1154313807
Provider Name (Legal Business Name): LLOYD C DYAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JAMES HOVATER RD
RUSSELLVILLE AL
35653-8004
US

IV. Provider business mailing address

PO BOX 626
RUSSELLVILLE AL
35653-0626
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-6208
  • Fax: 256-332-6213
Mailing address:
  • Phone: 256-332-6208
  • Fax: 256-332-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12405
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: