Provider Demographics
NPI:1437359486
Name:WILLIAM C LYON MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM C LYON MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-4113
Mailing Address - Street 1:1700 SAN PABLO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2081
Mailing Address - Country:US
Mailing Address - Phone:510-724-4113
Mailing Address - Fax:510-964-0607
Practice Address - Street 1:1700 SAN PABLO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2081
Practice Address - Country:US
Practice Address - Phone:510-724-4113
Practice Address - Fax:510-964-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22328207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41545Medicare UPIN
CA00G223280Medicare PIN