Provider Demographics
NPI:1538229638
Name:LYON, DAVID HOLLANDER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HOLLANDER
Last Name:LYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 579478
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-9478
Mailing Address - Country:US
Mailing Address - Phone:209-526-8624
Mailing Address - Fax:209-526-8625
Practice Address - Street 1:1100 KANSAS AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1596
Practice Address - Country:US
Practice Address - Phone:209-579-1151
Practice Address - Fax:209-579-9605
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA43180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431800Medicare PIN