Basic Information
| Provider Information | |||||||||
| NPI: | 1093994691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 S 27TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NEDERLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776276294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027500899 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1018 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561872202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073723800 | ||||||||
| FaxNumber: | 5073723806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 246604 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2594536000 | 05 | TX | MEDICAID | P00954990 | 01 | TX | RR MEDICARE | OTHER | TXB124763 | 01 | TX | MEDICARE PTAN TXB124763 | OTHER | TXB124762 | 01 | TX | MEDICARE GROUP PTAN | OTHER |