Provider Demographics
NPI:1245410901
Name:PYLE, JEREMY W (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:W
Last Name:PYLE
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 1:2304 WESVILL CT
Mailing Address - Street 2:SUITE 360
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2973
Mailing Address - Country:US
Mailing Address - Phone:919-785-1220
Mailing Address - Fax:
Practice Address - Street 1:2304 WESVILL CT
Practice Address - Street 2:SUITE 360
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2973
Practice Address - Country:US
Practice Address - Phone:919-785-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-02078208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery