Healthcare Provider Details

I. General information

NPI: 1538145693
Provider Name (Legal Business Name): WESLEY WARREN LYON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY SUITE 215
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

PO BOX 1344
OVERTON NV
89040-1344
US

V. Phone/Fax

Practice location:
  • Phone: 702-586-4600
  • Fax: 866-409-1683
Mailing address:
  • Phone: 702-293-5036
  • Fax: 866-409-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNV9807
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberNV9807
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: