Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | NV9807 | NV |
N | 213ES0131X | Foot Surgery | NV9807 | NV |
NPI | 1538145693 |
---|---|
Provider Name | Wesley Warren Lyon |
First Address | Overton, NV 89040-1344 |
Second Address | Las Vegas, NV 89128-0443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002102008 | (05) | NV |
U77208 | (02) | NV |