Provider Demographics
NPI:1427019058
Name:LYLE, DARREN B (MD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:B
Last Name:LYLE
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 1:4225 SW HUBER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6140
Mailing Address - Country:US
Mailing Address - Phone:503-868-2731
Mailing Address - Fax:707-500-4545
Practice Address - Street 1:4225 SW HUBER ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6140
Practice Address - Country:US
Practice Address - Phone:503-868-2731
Practice Address - Fax:707-500-4545
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR193238208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2434821000OtherPASSPORT ADVANTAGE
KY64288186Medicaid
KY1069834OtherPASSPORT
KY1069834OtherPASSPORT HEALTH PLAN
KY3317858Medicare PIN
KY2434821000OtherPASSPORT ADVANTAGE
KYF32401Medicare UPIN