Healthcare Provider Details

I. General information

NPI: 1447070826
Provider Name (Legal Business Name): LLYON MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 GREENWOOD AVE STE 213
WEST PALM BEACH FL
33407-2400
US

IV. Provider business mailing address

135 WATERVIEW COVE DR
FREEPORT FL
32439-2810
US

V. Phone/Fax

Practice location:
  • Phone: 561-203-9747
  • Fax:
Mailing address:
  • Phone: 850-687-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM MARCUS ROBERTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-687-6618