Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME122457 | FL |
NPI | 1063476364 |
---|---|
Provider Name | Kent J. Lyon |
First Address | Athens, GA 30606-7720 |
Second Address | Athens, GA 30606-7720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014539800 | (05) | FL |
10033 | BCBS (01) | FL |
1063476364 | TRICARE (01) | FL |