Healthcare Provider Details

I. General information

NPI: 1346511714
Provider Name (Legal Business Name): LYLE DON WORKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 MATLOCK RD SUITE 201
ARLINGTON TX
76015-2903
US

IV. Provider business mailing address

3120 MATLOCK RD SUITE 201
ARLINGTON TX
76015-2903
US

V. Phone/Fax

Practice location:
  • Phone: 817-467-0889
  • Fax: 817-557-4676
Mailing address:
  • Phone: 817-467-0889
  • Fax: 817-557-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ3128
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10042179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: