Provider Demographics
NPI:1639303134
Name:ROBERT C PYLE MD LLC
Entity Type:Organization
Organization Name:ROBERT C PYLE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-994-4523
Mailing Address - Street 1:PO BOX 9565
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-9565
Mailing Address - Country:US
Mailing Address - Phone:850-994-4523
Mailing Address - Fax:850-994-9130
Practice Address - Street 1:4225 WOODBINE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8790
Practice Address - Country:US
Practice Address - Phone:850-994-4523
Practice Address - Fax:850-994-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X, 207VE0102X
FLME124222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110408Medicaid
AL110408Medicaid