Provider Demographics
NPI:1386749653
Name:DYESS, JAMES MALCOLM (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MALCOLM
Last Name:DYESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MERGANSER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6607
Mailing Address - Country:US
Mailing Address - Phone:985-951-8941
Mailing Address - Fax:986-951-8943
Practice Address - Street 1:12 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3647
Practice Address - Country:US
Practice Address - Phone:504-368-3100
Practice Address - Fax:504-368-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA023074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721469018OtherTAX #
LA4A028Medicare ID - Type Unspecified
LAH32062Medicare UPIN