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General NPI Number Information
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NPI Number | 1447676697
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Entity Type | Organization
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Legal Business Name | WALNUT VALLEY FOOT AND ANKLE PA
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 1230 E 6TH AVE STE 2A
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City | WINFIELD
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State | KS
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Zip | 67156-3143
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Country | US
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Telephone | 620-221-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 E 6TH AVE STE 2A
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City | WINFIELD
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State | KS
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Zip | 67156-3145
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Country | US
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Telephone | 484-477-2584
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS P LYMAN
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Credential | DPM
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Telephone | 484-477-2584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 12-00399
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License Number State | KS
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