Healthcare Provider Details

I. General information

NPI: 1407861776
Provider Name (Legal Business Name): MARK S LYELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

IV. Provider business mailing address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

V. Phone/Fax

Practice location:
  • Phone: 228-819-8586
  • Fax: 251-433-1917
Mailing address:
  • Phone: 251-433-1895
  • Fax: 251-433-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13231
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: