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General NPI Number Information
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NPI Number | 1689706319
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Entity Type | Individual
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Provider Name | DALE ANTHONY LYONS IDC
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 9168 2ND ST STE 200 COMMANDER SUBMARINE SQUADRON SIX MEDICAL
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City | NORFOLK
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State | VA
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Zip | 23511-2323
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Country | US
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Telephone | 757-967-6175
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Fax | 757-967-6905
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Provider Business Mailing Address
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Address Line | 1900 FLAGLER CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8935
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Country | US
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Telephone | 808-783-9157
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Fax | 757-967-6905
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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