Provider Demographics
NPI:1124080031
Name:WEEKS, LYLE D (MD)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:D
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 N OREGON
Mailing Address - Street 2:STE 755
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3590
Mailing Address - Country:US
Mailing Address - Phone:915-541-1225
Mailing Address - Fax:915-541-1229
Practice Address - Street 1:1700 N OREGON
Practice Address - Street 2:STE 755
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3590
Practice Address - Country:US
Practice Address - Phone:915-541-1225
Practice Address - Fax:915-541-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE49592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126386Medicaid
TX8B5787Medicare ID - Type Unspecified
TX126386Medicaid