Provider Demographics
NPI:1588698872
Name:HUNT, LYLE B (MD)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:B
Last Name:HUNT
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 1:6480 PENTZ RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3672
Mailing Address - Country:US
Mailing Address - Phone:530-877-4983
Mailing Address - Fax:530-877-8621
Practice Address - Street 1:6480 PENTZ RD
Practice Address - Street 2:SUITE A
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3672
Practice Address - Country:US
Practice Address - Phone:530-877-4983
Practice Address - Fax:530-877-8621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG544660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ97927ZOtherBLUE SHIELD
CA020004649OtherRAILROAD MEDICARE
CA00G544660Medicaid
CA660066807OtherTRICARE
CAZZZ97927AOtherBLUE SHIELD
CAG544660OtherBLUE SHIELD HMO
CA680066807OtherBLUE CROSS
CAZZZ97927AOtherBLUE SHIELD