Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 3601 | WV |
NPI | 1194254441 |
---|---|
Provider Name | Dr. Jacob Lyon |
First Address | Huntington, WV 25701-3579 |
Second Address | Huntington, WV 25703-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 24/11/2021 |