Provider Demographics
NPI:1770698334
Name:FOLSOM, LYLE REY (DPM)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:REY
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4013
Mailing Address - Country:US
Mailing Address - Phone:575-885-3445
Mailing Address - Fax:575-887-0163
Practice Address - Street 1:1016 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4013
Practice Address - Country:US
Practice Address - Phone:575-885-3445
Practice Address - Fax:575-887-0163
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM281213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20639261Medicaid
NM480035354OtherRR MEDICARE
NMNM015A03OtherBCBS
NM480035354OtherRR MEDICARE
NM20639261Medicaid
NMU93603Medicare UPIN