Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35046423 | OH |
NPI | 1003856667 |
---|---|
Provider Name | John L Lyman |
First Address | Kettering, OH 45429-5164 |
Second Address | Franklin, OH 45005-2584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 23/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000316956 | BCBS (01) | OH |
000000326508 | BCBS FOR UVMC (01) | OH |
000000360666 | BCBS (01) | OH |
000000377131 | ANTHEM (01) | OH |
000000493504 | ANTHEM/BCBS (01) | OH |
000000559819 | ANTHEM (01) | OH |
0536003 | (05) | OH |
104734195 | MICHIGAN MEDICAID (01) | |
104808593 | (05) | MI |
C02662 | (02) |