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NPI Code Detail

MEDICARE: JOHN LYNCH LYLES MD

MEDICARE: JOHN LYNCH LYLES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22080P0206XPediatric Gastroenterology Physician2020-03566NC

General Provider Information

NPI Number : 1497174627
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LYNCH LYLES MD
Provider Business Mailing Address
First Line : PO BOX 110566
Second Line :
City : DURHAM
State : NC
Zip : 27709-5566
Country : US
Telephone Number : 919-620-4855
Fax Number :
Provider Business Practice Location Address
First Line : 4709 CREEKSTONE DR
Second Line :
City : DURHAM
State : NC
Zip : 27703-9822
Country : US
Telephone Number : 888-275-3853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 09/05/2023

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