Provider Demographics
NPI:1134128572
Name:BYERLY, LEE E (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:BYERLY
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 1:1501 W 11TH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4121
Mailing Address - Country:US
Mailing Address - Phone:432-264-7180
Mailing Address - Fax:
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:SUITE 204
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4119
Practice Address - Country:US
Practice Address - Phone:432-264-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2160207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147584001Medicaid
TX8A2658OtherBCBS OF TX
TXH42331Medicare UPIN
TX147584001Medicaid