MEDICARE: CHARLES MONROE LYON MD FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	D7623	TX
2	208600000X	Surgery Physician	98325	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184618555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MONROE LYON MD FACS

Provider Business Mailing Address
First Line	:	1900 N OREGON ST
Second Line	:	SUITE 400
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-533-8118
Fax Number	:	915-533-9669

Provider Business Practice Location Address
First Line	:	4311 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	505-556-6855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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