Provider Demographics
NPI:1316962483
Name:LYONS, EDWARD PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PATRICK
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2636
Mailing Address - Country:US
Mailing Address - Phone:337-235-8381
Mailing Address - Fax:337-235-1010
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-235-8381
Practice Address - Fax:337-235-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1157911Medicaid
LA1157911Medicaid
LA53768Medicare ID - Type Unspecified