=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609825207
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYLE DEAN HASKELL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5941 DALLAS PKWY STE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-9002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-758-4455
-----------------------------------------------------
Fax | 972-812-4196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 CENTRAL EXPY N SUITE 220
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-6103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-727-7060
-----------------------------------------------------
Fax | 972-727-0080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0979
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------