Provider Demographics
NPI:1386794162
Name:AMER, LYLE B (MD)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:B
Last Name:AMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 BROTHERS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6903
Mailing Address - Country:US
Mailing Address - Phone:505-983-9460
Mailing Address - Fax:505-983-0568
Practice Address - Street 1:2212 BROTHERS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6903
Practice Address - Country:US
Practice Address - Phone:505-983-9460
Practice Address - Fax:505-983-0568
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM87202207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP11158OtherMOLINA SALUD
NM14944Medicaid
NMNM020199OtherBCBS
NM201000218OtherPHP
NMNM020199OtherBCBS
E14192Medicare UPIN