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Dr. John Ora Lytle
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NPI Number Detailed Information
Provider Information:
Name: | Dr. John Ora Lytle |
Gender: | M |
Provider License Number If Given: | C6150 |
NPI Information:
NPI: | 1891780219 |
Entity Type (Individual or Organization): |
1-ind |
Enumeration Date: | 9/12/2005 |
Last Update Date: | 3/29/2016 |
Provider Business Mailing Address:
Address: | 1609 W 40TH AVE STE 501 Pine Bluff, AR 71603 |
Phone Number: | 8705343449 |
Fax Number: | 8705414297 |
Provider Business Practice Location Address:
Address: | 1609 W 40TH AVE STE 501 Pine Bluff, AR 71603 |
Phone Number: | 8705343449 |
Fax Number: | 8705414297 |
Provider Taxonomy:
Primary: | 207X00000X |
Secondary (if any): | |
State: | AR |