Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G68674 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G68674 | CA |
NPI | 1063444578 |
---|---|
Provider Name | Lyle Jonathan Reber |
First Address | La Quinta, CA 92248-6449 |
Second Address | La Quinta, CA 92253-8854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 12/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E83743 | (02) | CA |