Provider Demographics
NPI:1275670549
Name:LYLE, COURTNEY (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-2777
Practice Address - Fax:509-474-6222
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17181208000000X
CO46531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208000000XAllopathic & Osteopathic PhysiciansPediatrics