Provider Demographics
NPI:1225013311
Name:DILLARD, DONALD ROSS (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROSS
Last Name:DILLARD
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 1547
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1547
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:660-826-4852
Practice Address - Street 1:8000 AL HIGHWAY 69
Practice Address - Street 2:MARSHALL COUNTY MEDICAL CENTER NORTH
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7140
Practice Address - Country:US
Practice Address - Phone:256-571-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13066207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050091764OtherTRAVELERS MEDICARE
300117300OtherUMWA MEDICARE
051512175OtherBLUE CROSS BLUE SHIELD
AL051512175Medicaid
2000417OtherUNITED HEALTHCARE
AL051512175Medicare PIN
2000417OtherUNITED HEALTHCARE