Provider Demographics
NPI:1083682504
Name:LYONS, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LYONS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5230 BOULDER HWY STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6077
Practice Address - Country:US
Practice Address - Phone:802-940-1560
Practice Address - Fax:702-940-1561
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV9476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9476OtherSTATE LICENSE
NV002018461Medicaid
NVV107422Medicare PIN