Provider Demographics
NPI:1154313807
Name:DYAS, LLOYD C (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:C
Last Name:DYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0626
Mailing Address - Country:US
Mailing Address - Phone:256-332-6208
Mailing Address - Fax:256-332-6213
Practice Address - Street 1:101 JAMES HOVATER RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-8004
Practice Address - Country:US
Practice Address - Phone:256-332-6208
Practice Address - Fax:256-332-6213
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12405207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045543Medicaid
4076990001Medicare NSC
AL000045543Medicare ID - Type Unspecified
AL000045543Medicaid