Healthcare Provider Details

I. General information

NPI: 1871684076
Provider Name (Legal Business Name): ROBERT EARNEST LYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512-1
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

PO BOX 251418
LITTLE ROCK AR
72225-1418
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-3641
  • Fax: 501-364-4264
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-7351
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC-7351
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: