Provider Demographics
NPI:1467477547
Name:LYTLE, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:LYTLE
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 1:6729 DEERFOOT PKWY
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3093
Mailing Address - Country:US
Mailing Address - Phone:205-681-5377
Mailing Address - Fax:205-681-6276
Practice Address - Street 1:6729 DEERFOOT PKWY
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3093
Practice Address - Country:US
Practice Address - Phone:205-681-5377
Practice Address - Fax:205-681-6276
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1661050OtherUNITED HEALTHCARE
AL7892304OtherCIGNA
AL51026568OtherBC/BS
AL51506245OtherBC/BS
AL000026568Medicaid
AL000026568Medicaid