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General NPI Number Information
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NPI Number | 1588227797
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Entity Type | Individual
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Provider Name | DANE PHILLIP LYMAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 910 S 300 W
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City | BLANDING
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State | UT
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Zip | 84511-3921
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Country | US
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Telephone | 435-678-0700
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Fax | 435-678-0707
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | MONTEZUMA CREEK
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State | UT
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Zip | 84534-0130
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Country | US
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Telephone | 435-651-3700
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Fax | 435-678-0707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11982449-1205
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License Number State | UT
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