Provider Demographics
NPI:1407861776
Name:LYELL, MARK S (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:LYELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:168 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3510
Mailing Address - Country:US
Mailing Address - Phone:251-433-1895
Mailing Address - Fax:251-433-1917
Practice Address - Street 1:1153 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-819-8586
Practice Address - Fax:251-433-1917
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2025-05-22
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Provider Licenses
StateLicense IDTaxonomies
MS13231208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119318Medicaid
MS10980353OtherCAQH
MS340018613OtherRAILROAD MEDICARE
MS340000216Medicare ID - Type Unspecified