Provider Demographics
NPI:1730260159
Name:LYTLE, WILLIAM FRANKLIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANKLIN
Last Name:LYTLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4500 STUART ST
Mailing Address - Street 2:MACH ATTN: MCXL-PQ (CREDENTIALS)
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-5700
Mailing Address - Country:US
Mailing Address - Phone:803-751-2618
Mailing Address - Fax:803-751-2689
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:MACH ATTN: MCXL-PQ (CREDENTIALS)
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-2618
Practice Address - Fax:803-751-2689
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCVADOther000