Healthcare Provider Details

I. General information

NPI: 1891796330
Provider Name (Legal Business Name): RICKY DUANE LYERLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

PO BOX 1430
ASHEBORO NC
27204-1430
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-6565
  • Fax: 336-626-5640
Mailing address:
  • Phone: 336-629-6565
  • Fax: 336-626-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: