Healthcare Provider Details

I. General information

NPI: 1780716563
Provider Name (Legal Business Name): VICKI J LYONS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD SUITE 4640
OGDEN UT
84403-3271
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 4640
OGDEN UT
84403-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-4850
  • Fax: 801-387-4855
Mailing address:
  • Phone: 801-387-4850
  • Fax: 801-387-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number272784-1205
License Number StateUT

VIII. Authorized Official

Name: VICKI J LYONS
Title or Position: OWNER
Credential: M.D.
Phone: 801-387-4850