Healthcare Provider Details

I. General information

NPI: 1699079590
Provider Name (Legal Business Name): LYLE B AMER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 BROTHERS RD
SANTA FE NM
87505-6903
US

IV. Provider business mailing address

2212 BROTHERS RD
SANTA FE NM
87505-6903
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-9460
  • Fax: 505-983-0568
Mailing address:
  • Phone: 505-983-9460
  • Fax: 505-983-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberNM87-202
License Number StateNM

VIII. Authorized Official

Name: LYLE B AMER
Title or Position: OWNER
Credential: MD
Phone: 505-983-9460