Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME125365 | FL |
NPI | 1053504308 |
---|---|
Provider Name | Dr. Mark Edward Lytle |
First Address | Pensacola, FL 32524-1982 |
Second Address | Pensacola, FL 32504-8756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 27/01/2022 |