1154377968 NPI number — RICHARD HOWARD LYERLY M.D.

Table of content: RICHARD HOWARD LYERLY M.D. (NPI 1154377968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154377968 NPI number — RICHARD HOWARD LYERLY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYERLY
Provider First Name:
RICHARD
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYERLY
Provider Other First Name:
RICK
Provider Other Middle Name:
HOWARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154377968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-250-6000
Provider Business Mailing Address Fax Number:
205-250-6848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 SAINT VINCENTS DR
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-250-8946
Provider Business Practice Location Address Fax Number:
205-250-6002
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  7699 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000005711 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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