Provider Demographics
NPI:1528012226
Name:DYESS, DONNA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:DYESS
Suffix:
Gender:F
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5763
Mailing Address - Fax:251-660-5752
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 2N
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-660-5763
Practice Address - Fax:251-660-5752
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11290208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000013013Medicaid
AL17-10302OtherUNITED HEALTH CARE
FL055765000Medicaid
MS00011059Medicaid
LA1583677Medicaid
AL51013013OtherBLUE CROSS
AL17-10302OtherUNITED HEALTH CARE
AL000013013Medicaid
GA020009562Medicare ID - Type UnspecifiedPGBA RAILROAD