Healthcare Provider Details

I. General information

NPI: 1811012503
Provider Name (Legal Business Name): LYLE D HASKELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N SUITE 220
ALLEN TX
75013-6103
US

IV. Provider business mailing address

1105 CENTRAL EXPY N SUITE 220
ALLEN TX
75013-6103
US

V. Phone/Fax

Practice location:
  • Phone: 972-727-7060
  • Fax: 972-727-0080
Mailing address:
  • Phone: 972-727-7060
  • Fax: 972-727-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0979
License Number StateTX

VIII. Authorized Official

Name: LYLE D HASKELL
Title or Position: OWNER
Credential: DPM
Phone: 972-727-7060