Healthcare Provider Details

I. General information

NPI: 1376540393
Provider Name (Legal Business Name): JUSTIN STRYDER LYMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 W MCNEESE ST
LAKE CHARLES LA
70605-5530
US

IV. Provider business mailing address

608 W MCNEESE ST
LAKE CHARLES LA
70605-5530
US

V. Phone/Fax

Practice location:
  • Phone: 337-477-8757
  • Fax: 337-477-8758
Mailing address:
  • Phone: 337-477-8757
  • Fax: 337-477-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD.201804
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: