Provider Demographics
NPI:1780776120
Name:LYLE, DOUGLAS P (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:LYLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24411 HEALTH CENTER DR
Mailing Address - Street 2:#550
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-770-6252
Mailing Address - Fax:949-916-0140
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:#550
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-770-6252
Practice Address - Fax:949-916-0140
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-03-30
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Provider Licenses
StateLicense IDTaxonomies
CAC36916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36406Medicare UPIN
CABL346ZMedicare PIN