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General NPI Number Information
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NPI Number | 1477060218
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Entity Type | Organization
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Legal Business Name | DYKES MEDICAL PLLC
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 101 MILLS ST
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2521
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Country | US
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Telephone | 601-833-5608
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Fax | 601-823-6777
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Provider Business Mailing Address
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Address Line | 102 LOBLOLLY LN NE
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City | BROOKHAVEN
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State | MS
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Zip | 39601-9217
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Country | US
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Telephone | 601-695-9464
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Fax | 601-823-6777
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. PAUL GERRIT DYKES
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Credential | MD
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Telephone | 601-695-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MS15940
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License Number State | MS
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