Basic Information
| Provider Information | |||||||||
| NPI: | 1639186588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYLE | ||||||||
| FirstName: | SANFORD | ||||||||
| MiddleName: | PHILIP | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S ANAHEIM HILLS RD | ||||||||
| Address2: | #136 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928074780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148288160 | ||||||||
| FaxNumber: | 7142827031 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S ANAHEIM HILLS RD | ||||||||
| Address2: | #136 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928074780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148288160 | ||||||||
| FaxNumber: | 7142827031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G22147 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.