Provider Demographics
NPI:1649467739
Name:LYLE, DEREK DENTON (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:DENTON
Last Name:LYLE
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 1:2110 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7328
Mailing Address - Country:US
Mailing Address - Phone:760-516-5145
Mailing Address - Fax:
Practice Address - Street 1:2110 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7328
Practice Address - Country:US
Practice Address - Phone:760-516-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93988207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology