1700872504 NPI number — DR. F. LYLE WALTERS BARKSDALE M.D.

Table of content: DR. F. LYLE WALTERS BARKSDALE M.D. (NPI 1700872504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700872504 NPI number — DR. F. LYLE WALTERS BARKSDALE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARKSDALE
Provider First Name:
F.
Provider Middle Name:
LYLE WALTERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARKSDALE
Provider Other First Name:
LYLE
Provider Other Middle Name:
WALTERS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700872504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1289
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69103-1289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-532-4700
Provider Business Mailing Address Fax Number:
308-534-0534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W LEOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-6578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-532-4700
Provider Business Practice Location Address Fax Number:
308-534-0534
Provider Enumeration Date:
09/27/2005

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: 207ZP0102X , with the licence number:  15626 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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