Basic Information
| Provider Information | |||||||||
| NPI: | 1689647331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23540 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921933540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585650950 | ||||||||
| FaxNumber: | 8582441100 | ||||||||
| Practice Location | |||||||||
| Address1: | 8745 AERO DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585650950 | ||||||||
| FaxNumber: | 8582441100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A36265 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085U0001X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085N0700X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0203X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 208VP0014X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | A36265 | CA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0083810 | 05 | CA | MEDICAID | GR0083814 | 05 | CA | MEDICAID | GR0083812 | 05 | CA | MEDICAID | GR0083817 | 05 | CA | MEDICAID | ZZZ75341Z | 05 | CA | MEDICAID | GR0083811 | 05 | CA | MEDICAID | GR0083816 | 05 | CA | MEDICAID | GR0083813 | 05 | CA | MEDICAID | GR0083815 | 05 | CA | MEDICAID |