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Organization
LYLE E WADSWORTH MD PA
Active
Organization
LYLE E WADSWORTH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE E. WADSWORTH MD (PRESIDENT)
(386) 740-0224
Entity
Organization
Contact information
Practice address
890 N BOUNDARY AVE STE 102, DELAND, FL 32720-3173
(386) 740-0224
Mailing address
890 N BOUNDARY AVE STE 102, DELAND, FL 32720-3173
(386) 740-0224
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME30902
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
ME30902
FL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
ME30902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050266105
UNITEDHEALTHCARE
FL
01
—
2198298007
CIGNA
FL
01
—
5490138
AETNA
FL
01
—
64391
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/30/2007
Last updated
03/06/2008
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