Healthcare Provider Details

I. General information

NPI: 1447247168
Provider Name (Legal Business Name): LYLE HOWARD GUMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MIRACLE MILE SUITE 201
CORAL GABLES FL
33134-4930
US

IV. Provider business mailing address

401 MIRACLE MILE SUITE 201
CORAL GABLES FL
33134-4930
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-8423
  • Fax: 305-446-0262
Mailing address:
  • Phone: 305-446-8423
  • Fax: 305-446-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0S3791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: