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NPI Code Detail

MEDICARE: CHARLES ROGER LYONS JR. MD

MEDICARE: CHARLES ROGER LYONS JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01022249IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000082846OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
310336OTHERPHP

General Provider Information

NPI Number : 1235139460
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES ROGER LYONS JR. MD
Provider Business Mailing Address
First Line : 1025 MANCHESTER AVE
Second Line :
City : WABASH
State : IN
Zip : 46992-1425
Country : US
Telephone Number : 260-563-7421
Fax Number : 260-563-7725
Provider Business Practice Location Address
First Line : 1025 MANCHESTER AVE
Second Line :
City : WABASH
State : IN
Zip : 46992-1425
Country : US
Telephone Number : 260-563-7421
Fax Number : 260-563-7725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 05/13/2008

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