Provider Demographics
NPI:1689706319
Name:LYONS, DALE ANTHONY (IDC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ANTHONY
Last Name:LYONS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FLAGLER CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8935
Mailing Address - Country:US
Mailing Address - Phone:808-783-9157
Mailing Address - Fax:757-967-6905
Practice Address - Street 1:9168 2ND ST STE 200
Practice Address - Street 2:COMMANDER SUBMARINE SQUADRON SIX MEDICAL
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2323
Practice Address - Country:US
Practice Address - Phone:757-967-6175
Practice Address - Fax:757-967-6905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman