Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | R2C26 | MO |
NPI | 1013920651 |
---|---|
Provider Name | Dr. Alan P Lyss |
First Address | Saint Louis, MO 63131-2329 |
Second Address | Saint Louis, MO 63131-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A13988 | (02) |