Provider Demographics
NPI:1285685891
Name:LYON, JULIE DIANA (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DIANA
Last Name:LYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14820 E 4TH AVE
Mailing Address - Street 2:SULLIVAN PARK CARE CENTER
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2165
Mailing Address - Country:US
Mailing Address - Phone:509-922-1644
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-381-4100
Practice Address - Fax:208-381-1665
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7622208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist