Provider Demographics
NPI:1831202365
Name:LYONS, LEWIS CLINTON (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:CLINTON
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S COULTER ST
Mailing Address - Street 2:BLDG C - 302
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-356-9500
Mailing Address - Fax:806-356-9573
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:BLDG C - 302
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-356-9500
Practice Address - Fax:806-356-9573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0991OtherTEXAS LICENSE
TXJ0991OtherTEXAS LICENSE
TXOOH71FMedicare ID - Type UnspecifiedMEDICARE