Provider Demographics
NPI:1447247168
Name:GUMER, LYLE HOWARD (DO)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:HOWARD
Last Name:GUMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 MIRACLE MILE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4930
Mailing Address - Country:US
Mailing Address - Phone:305-446-8423
Mailing Address - Fax:305-446-0262
Practice Address - Street 1:401 MIRACLE MILE
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4930
Practice Address - Country:US
Practice Address - Phone:305-446-8423
Practice Address - Fax:305-446-0262
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0S3791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27357Medicare UPIN
FL82281Medicare ID - Type Unspecified