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Individual

MR. MATTHEW LAMAR LYLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 730-6700
(985) 730-6713
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APO4029
LA
367500000X
Certified Registered Nurse Anesthetist
C02817
AR
367500000X
Certified Registered Nurse Anesthetist
RN089353
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1740210061
MO
05
183618001
AR
05
200497160A
OK
Enumeration date
07/03/2006
Last updated
07/07/2021
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