Healthcare Provider Details

I. General information

NPI: 1700052966
Provider Name (Legal Business Name): LEWIS CLINTON LYONS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TREY LYONS

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SPRING HILL AVE
MOBILE AL
36607-2301
US

IV. Provider business mailing address

1855 SPRING HILL AVE
MOBILE AL
36607-3592
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-3544
  • Fax:
Mailing address:
  • Phone: 251-471-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39358
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE9259
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: