Basic Information
| Provider Information | |||||||||
| NPI: | 1457529612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TONY L LLOYD M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 188 | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953610188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098451350 | ||||||||
| FaxNumber: | 2098451364 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 GUZZI LN | ||||||||
| Address2: | STE 106 | ||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953705288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095888840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | LLOYD | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2095888840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A88900 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0414937 | 05 | CA | MEDICAID |