Provider Demographics
NPI:1154314011
Name:LYONS, DENNIS J (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:LYONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19183
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-0183
Mailing Address - Country:US
Mailing Address - Phone:510-530-0840
Mailing Address - Fax:510-530-0873
Practice Address - Street 1:4247 MAC ARTHUR BLVD.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1907
Practice Address - Country:US
Practice Address - Phone:510-530-0840
Practice Address - Fax:510-530-0873
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2283213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5006060001OtherDME NORIDIAN
CA000E22830Medicaid
CA5006060001OtherDME NORIDIAN