Healthcare Provider Details

I. General information

NPI: 1588619506
Provider Name (Legal Business Name): CARTER S LYTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number349518-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: