Healthcare Provider Details

I. General information

NPI: 1699783928
Provider Name (Legal Business Name): ERIC M. DYESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR SUITE 450
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR SUITE 450
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-5158
  • Fax: 601-949-6058
Mailing address:
  • Phone: 601-948-5158
  • Fax: 601-949-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number10268
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: