Individual
DR. LYLE E WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
890 N BOUNDARY AVE, STE 102, DELAND, FL 32720-3173
(386) 740-0224
(386) 740-9711
Mailing address
890 N BOUNDARY AVE, STE 102, DELAND, FL 32720-3173
(386) 740-0224
(386) 740-9711
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME30902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050266105
UNITEDHEALTHCARE
FL
01
—
2198298007
CIGNA
FL
01
—
5490138
AETNA
FL
01
—
64391
BC/BS
FL
Enumeration date
06/22/2005
Last updated
03/27/2008
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