Healthcare Provider Details

I. General information

NPI: 1457449126
Provider Name (Legal Business Name): ERIC M LYDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 COLE BLVD SUITE 150
LAKEWOOD CO
80401-3208
US

IV. Provider business mailing address

1746 COLE BLVD SUITE 150
LAKEWOOD CO
80401-3208
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-8800
  • Fax: 303-716-3777
Mailing address:
  • Phone: 303-914-8800
  • Fax: 303-716-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50047
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200601249
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101247400
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: