Healthcare Provider Details

I. General information

NPI: 1578516076
Provider Name (Legal Business Name): RALPH THOMAS LYERLY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CARRAWAY BLVD SUITE 220
BIRMINGHAM AL
35234-1955
US

IV. Provider business mailing address

3400 HIGHWAY 78 E MEDICAL ARTS TOWER, SUITE 406
TALLADEGA AL
35501
US

V. Phone/Fax

Practice location:
  • Phone: 205-502-1700
  • Fax: 205-502-1710
Mailing address:
  • Phone: 205-384-4212
  • Fax: 205-387-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5666
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: