Healthcare Provider Details

I. General information

NPI: 1790811974
Provider Name (Legal Business Name): LYMAN RELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUMC 3938
DURHAM NC
27710-0001
US

IV. Provider business mailing address

DUMC 3938
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-6474
  • Fax:
Mailing address:
  • Phone: 919-684-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number33119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: