Provider Demographics
NPI:1558314419
Name:LYRENE, GEORGE A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:LYRENE
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 1:600 SAINT CLAIR AVE SW
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5008
Mailing Address - Country:US
Mailing Address - Phone:256-536-4700
Mailing Address - Fax:256-536-4117
Practice Address - Street 1:600 SAINT CLAIR AVE SW
Practice Address - Street 2:BUILDING 3
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5008
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:256-536-4117
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL503214OtherUNITED HEALTHCARE
AL138174Medicaid
AL51125632OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
AL138174Medicaid
ALC78868Medicare UPIN