Provider Demographics
NPI:1558318881
Name:LYONS, HARVEY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:DAVID
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:2921 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5314
Practice Address - Country:US
Practice Address - Phone:805-487-5588
Practice Address - Fax:805-587-5589
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38214207RN0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18553HMedicaid
CA050394OtherBLUE CROSS
CAZZT40394FMedicaid
CARHM08608FMedicaid
CARHM08609FMedicaid
CA95-1683892OtherOTHER INSURANCE
CARHM08608FMedicaid
CAWC38214NMedicare ID - Type UnspecifiedPPIN
CAWC38214LMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CA050394OtherBLUE CROSS
CA050394Medicare ID - Type UnspecifiedMEDICARE
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CAWC38214MMedicare ID - Type UnspecifiedPPIN
CA95-1683892OtherOTHER INSURANCE
CA058609Medicare ID - Type UnspecifiedRH MEDICARE