Healthcare Provider Details

I. General information

NPI: 1043378060
Provider Name (Legal Business Name): LAWRENCE LYONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/09/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

06B MAIN STREET
CERRILLOS NM
87010
US

IV. Provider business mailing address

PO BOX 2267
SANTA FE NM
87504-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-6266
  • Fax: 505-471-5861
Mailing address:
  • Phone: 505-820-3478
  • Fax: 505-989-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77-213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: