Provider Demographics
NPI:1740574581
Name:LYSTAD, ERIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:LYSTAD
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2600 E PFLUGERVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5999
Practice Address - Country:US
Practice Address - Phone:512-654-6100
Practice Address - Fax:512-654-6101
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60652453207Q00000X, 208M00000X
COCDR.0001960207Q00000X
TXT5760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist