Provider Demographics
NPI:1326013574
Name:LYONS, VICKI J (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:LYONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 4640
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3271
Mailing Address - Country:US
Mailing Address - Phone:801-387-4850
Mailing Address - Fax:801-387-4855
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 4640
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-4850
Practice Address - Fax:801-387-4855
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT272784-1205207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00069425OtherRAILROAD MEDICARE
UT005741501Medicare PIN
UTP00069425OtherRAILROAD MEDICARE