MEDICARE: FRED LYLES M.D.

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
1	207P00000X	Emergency Medicine Physician	C6852	AR
2	207Q00000X	Family Medicine Physician	C6852	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609826486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED LYLES M.D.

Provider Business Mailing Address
First Line	:	1661 AIRPORT RD STE D
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8184
Country	:	US
Telephone Number	:	501-624-7500
Fax Number	:	501-625-7777

Provider Business Practice Location Address
First Line	:	1629 AIRPORT RD STE B
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8069
Country	:	US
Telephone Number	:	501-767-0075
Fax Number	:	501-760-2739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/10/2021

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