Provider Demographics
NPI:1932139862
Name:LYON, TIMOTHY L (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:LYON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 VERMONT ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4845
Mailing Address - Country:US
Mailing Address - Phone:330-268-9390
Mailing Address - Fax:
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-389-1100
Practice Address - Fax:956-389-1800
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89405HMedicare ID - Type Unspecified