Provider Demographics
NPI:1477901247
Name:LYALL, ERIC JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEFFREY
Last Name:LYALL
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:UW HOSPITALS AND CLINICS
Mailing Address - Street 2:600 HIGHLAND AVE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-3218
Mailing Address - Country:US
Mailing Address - Phone:770-356-9627
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:UW HOSPITALS AND CLINICS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6514-851207P00000X
IDM-14616207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine