Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD025800E | PA |
NPI | 1477544583 |
---|---|
Provider Name | John Cornelius Lyons |
First Address | Erie, PA 16505-2248 |
Second Address | Erie, PA 16505-4508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E55497 | (02) | PA |