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General NPI Number Information
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NPI Number | 1609665892
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Entity Type | Organization
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Legal Business Name | DCTR LLYD, LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 300 SE D ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-6042
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Country | US
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Telephone | 405-317-4893
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 S CHAMPIONS DR
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City | ROGERS
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State | AR
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Zip | 72758-8896
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Country | US
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Telephone | 405-317-4893
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. TYLER BROOKES LLOYD
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Credential | MD
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Telephone | 405-317-4893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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