Provider Demographics
NPI:1467477729
Name:BROWN, LYLE L (MD)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:L
Last Name:BROWN
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 1:3316 N UNIVERSITY DR STE C
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2607
Mailing Address - Country:US
Mailing Address - Phone:936-559-0800
Mailing Address - Fax:936-559-0803
Practice Address - Street 1:3316 N UNIVERSITY DR STE C
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2607
Practice Address - Country:US
Practice Address - Phone:936-559-0800
Practice Address - Fax:936-559-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5017208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00708949OtherRAILROAD MEDICARE
TX75260358175090D019OtherTRICARE
TX8A9266OtherBLUE CROSS BLUE SHIELD
TX116097006Medicaid
TX8BZ666OtherBLUE CROSS BLUE SHIELD
TXP00185417OtherRAILROAD MEDICARE
TX116097007Medicaid
TX8F21216Medicare PIN
TXP00185417OtherRAILROAD MEDICARE
TX116097006Medicaid