Provider Demographics
NPI:1295003853
Name:DYKES, RONALD HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HARRIS
Last Name:DYKES
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 1:115 MOUNTAIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-7529
Mailing Address - Country:US
Mailing Address - Phone:256-574-3358
Mailing Address - Fax:
Practice Address - Street 1:115 MOUNTAIN BROOK DR
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-7529
Practice Address - Country:US
Practice Address - Phone:256-574-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8035207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology