Provider Demographics
NPI:1467114629
Name:LYTLE, ANTHONY DAVID (NMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:LYTLE
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8608
Mailing Address - Country:US
Mailing Address - Phone:480-924-5063
Mailing Address - Fax:602-960-8867
Practice Address - Street 1:4012 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8608
Practice Address - Country:US
Practice Address - Phone:480-924-5063
Practice Address - Fax:602-960-8867
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1683175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath