Provider Demographics
NPI:1508834953
Name:LYONS, VAL OWEN (MD)
Entity Type:Individual
Prefix:
First Name:VAL
Middle Name:OWEN
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 1:801 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3443
Mailing Address - Country:US
Mailing Address - Phone:641-228-1143
Mailing Address - Fax:641-228-7621
Practice Address - Street 1:801 13TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3443
Practice Address - Country:US
Practice Address - Phone:641-228-1143
Practice Address - Fax:641-228-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2073213Medicaid
IAE97419Medicare UPIN
IA10666Medicare ID - Type Unspecified