Provider Demographics
NPI:1669547469
Name:LYLE, LARRY NEAL (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEAL
Last Name:LYLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3719 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3312
Mailing Address - Country:US
Mailing Address - Phone:619-368-3408
Mailing Address - Fax:619-299-4775
Practice Address - Street 1:3719 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3312
Practice Address - Country:US
Practice Address - Phone:619-368-3408
Practice Address - Fax:619-299-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG09589Medicare UPIN