Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01039264A | IN |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01039264A | IN |
NPI | 1346294360 |
---|---|
Provider Name | Dr. Carlton L. Lyons |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 29/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100336130 | (05) | IN |
E82934 | (02) | IN |