Healthcare Provider Details

I. General information

NPI: 1639303134
Provider Name (Legal Business Name): ROBERT C PYLE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 WOODBINE RD SUITE C
PACE FL
32571-8790
US

IV. Provider business mailing address

PO BOX 9565
PENSACOLA FL
32513-9565
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-4523
  • Fax: 850-994-9130
Mailing address:
  • Phone: 850-994-4523
  • Fax: 850-994-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME12422
License Number StateFL

VIII. Authorized Official

Name: ROBERT C. PYLE
Title or Position: OWNER
Credential: MD
Phone: 850-994-4523