Provider Demographics
NPI:1053740670
Name:LYLE J REBER MD, INC.
Entity type:Organization
Organization Name:LYLE J REBER MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-972-4580
Mailing Address - Street 1:PO BOX 6449
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6449
Mailing Address - Country:US
Mailing Address - Phone:760-972-4580
Mailing Address - Fax:
Practice Address - Street 1:47110 WASHINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2186
Practice Address - Country:US
Practice Address - Phone:760-972-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAR ORTHOPAEDICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies