Provider Demographics
NPI:1104027234
Name:MASON, LYLE BEYER (MD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:BEYER
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1708 STONE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1033
Mailing Address - Country:US
Mailing Address - Phone:801-295-7604
Mailing Address - Fax:801-295-7604
Practice Address - Street 1:1708 STONE RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-1033
Practice Address - Country:US
Practice Address - Phone:801-295-7604
Practice Address - Fax:801-295-7604
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT162465-1205207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery