Healthcare Provider Details

I. General information

NPI: 1205363157
Provider Name (Legal Business Name): LYLE HASKELL DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 220
ALLEN TX
75013-6102
US

IV. Provider business mailing address

1105 CENTRAL EXPY N STE 220
ALLEN TX
75013-6102
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number979
License Number StateTX

VIII. Authorized Official

Name: DR. LYLE DEAN HASKELL
Title or Position: PRESIDENT
Credential: DPM
Phone: 972-727-7060