Provider Demographics
NPI:1780312496
Name:LANCASTER, KYLE HUGH (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:HUGH
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 HALCYON BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8044
Mailing Address - Country:US
Mailing Address - Phone:334-530-6387
Mailing Address - Fax:334-612-7540
Practice Address - Street 1:1855 HALCYON BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8044
Practice Address - Country:US
Practice Address - Phone:334-530-5387
Practice Address - Fax:334-612-7540
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.5788R390200000X
AL3966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program