Healthcare Provider Details

I. General information

NPI: 1548290844
Provider Name (Legal Business Name): RALPH THOMAS LYERLY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

2151 OLD ROCKY RIDGE RD SUITE 106
BIRMINGHAM AL
35216-7235
US

V. Phone/Fax

Practice location:
  • Phone: 205-989-1080
  • Fax:
Mailing address:
  • Phone: 205-989-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.24332
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: