Provider Demographics
NPI:1043270929
Name:PYLES, JERALD D (MD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:D
Last Name:PYLES
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:PO BOX 63314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3314
Mailing Address - Country:US
Mailing Address - Phone:828-696-1312
Mailing Address - Fax:828-696-1314
Practice Address - Street 1:705 6TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4164
Practice Address - Country:US
Practice Address - Phone:828-692-2231
Practice Address - Fax:828-692-9742
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969555Medicaid
NC209759AMedicare ID - Type Unspecified
NC8969555Medicaid