Provider Demographics
NPI:1538145693
Name:LYON, WESLEY WARREN (DPM)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:WARREN
Last Name:LYON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1344
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:NV
Mailing Address - Zip Code:89040-1344
Mailing Address - Country:US
Mailing Address - Phone:702-293-5036
Mailing Address - Fax:866-409-1683
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-586-4600
Practice Address - Fax:866-409-1683
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV9807213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102008Medicaid
NV002102008Medicaid
NVU77208Medicare UPIN