MEDICARE: LLOYD C DYAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	12405	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154313807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD C DYAS MD

Provider Business Mailing Address
First Line	:	PO BOX 626
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-0626
Country	:	US
Telephone Number	:	256-332-6208
Fax Number	:	256-332-6213

Provider Business Practice Location Address
First Line	:	101 JAMES HOVATER RD
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-8004
Country	:	US
Telephone Number	:	256-332-6208
Fax Number	:	256-332-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	06/11/2015

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