Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 22440 | IA |
NPI | 1427045798 |
---|---|
Provider Name | Dr. Dean P Lyons |
First Address | West Burlington, IA 52655-1694 |
Second Address | West Burlington, IA 52655-1694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 12/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0183988 | (05) | IA |
18398 | WELLMARK (01) | IA |
A01822 | (02) | IA |