Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M-10680 | ID |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M10680 | ID |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M10680 | ID |
N | 207XX0801X | Orthopaedic Trauma Surgeon | M10680 | ID |
NPI | 1316945876 |
---|---|
Provider Name | Dr. Jeffrey Robert Rees Lyman |
First Address | Coeur D Alene, ID 83814-6190 |
Second Address | Coeur D Alene, ID 83814-6190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 16/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H89752 | (02) |