Provider Demographics
NPI:1386645372
Name:LYDAY, VICTOR IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:IVAN
Last Name:LYDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 361
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-224-2639
Mailing Address - Fax:210-224-1472
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 361
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-224-2639
Practice Address - Fax:210-224-1472
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD9554207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18624Medicare UPIN
TX00AN97Medicare ID - Type Unspecified