Provider Demographics
NPI:1467554683
Name:LYLE, DIANA CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CAROL
Last Name:LYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAROL
Other - Last Name:LYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8226 DOUGLAS AVE #449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:214-750-0801
Mailing Address - Fax:214-750-0804
Practice Address - Street 1:8226 DOUGLAS AVE #449
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-750-0801
Practice Address - Fax:214-750-0804
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6073208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000M1486Medicaid
03393700OtherDMERC
D6073OtherSTATE BOARD
TX00M148Medicare ID - Type Unspecified
03393700OtherDMERC