Healthcare Provider Details

I. General information

NPI: 1033238522
Provider Name (Legal Business Name): DAVID LYMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE
ALBUQUERQUE NM
87109-3573
US

IV. Provider business mailing address

5700 HARPER DR NE
ALBUQUERQUE NM
87109-3573
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-9166
  • Fax: 505-858-0030
Mailing address:
  • Phone: 505-823-9166
  • Fax: 505-858-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number95-287
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: