Healthcare Provider Details

I. General information

NPI: 1649310517
Provider Name (Legal Business Name): JIM OTIS LLOYD DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 FERRIS AVE
WAXAHACHIE TX
75165-1861
US

IV. Provider business mailing address

1311 FERRIS AVE
WAXAHACHIE TX
75165-1861
US

V. Phone/Fax

Practice location:
  • Phone: 972-935-9700
  • Fax:
Mailing address:
  • Phone: 972-935-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK2950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: