Provider Demographics
NPI:1861474827
Name:DYKES, PAUL G (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:G
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 1:513C BROOKMAN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2326
Mailing Address - Country:US
Mailing Address - Phone:601-833-3822
Mailing Address - Fax:601-835-4330
Practice Address - Street 1:513C BROOKMAN DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2326
Practice Address - Country:US
Practice Address - Phone:601-833-3822
Practice Address - Fax:601-835-4330
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15940207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS008059229Medicaid
390000133Medicare ID - Type Unspecified
H36951Medicare UPIN