Healthcare Provider Details

I. General information

NPI: 1659542082
Provider Name (Legal Business Name): LLOYD C DYAS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 05/29/2008
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD DYAS
Title or Position: OWNER
Credential: MD
Phone: 256-332-6208