Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0102204935 | VA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | R8232 | TX |
NPI | 1164786638 |
---|---|
Provider Name | Megan R Lyle |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
391182801 | (05) | TX |
391182802 | (05) | TX |