Provider Demographics
NPI:1235154287
Name:LYONS, THOMAS REED (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:REED
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD STE 600B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3023
Mailing Address - Country:US
Mailing Address - Phone:504-454-2191
Mailing Address - Fax:504-454-3106
Practice Address - Street 1:4228 HOUMA BLVD STE 600B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3023
Practice Address - Country:US
Practice Address - Phone:504-454-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480584Medicaid
LAG69317Medicare UPIN
LA1480584Medicaid