Provider Demographics
NPI:1912410895
Name:DAVID W LYTER, MD MPH, PA
Entity Type:Organization
Organization Name:DAVID W LYTER, MD MPH, PA
Other - Org Name:DIVERSITY HEALTH CENTER OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:LYTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-518-0881
Mailing Address - Street 1:4302 N HABANA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6368
Mailing Address - Country:US
Mailing Address - Phone:813-518-0881
Mailing Address - Fax:813-518-0882
Practice Address - Street 1:4302 N HABANA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6368
Practice Address - Country:US
Practice Address - Phone:813-518-0881
Practice Address - Fax:813-518-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023374100Medicaid