Basic Information
| Provider Information | |||||||||
| NPI: | 1558529222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEMON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12358 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309142358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 CHANNING WAY | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | O-0717 | ID | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 208600000X | 28016 | MS | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 88821 | MT | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2020-04127 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | CL0098 | NV | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 83406 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | DO0000004141 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | S9021 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0102206365 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 12895C | WY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 175042 | AK | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 81691 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | CDR.0000804 | CO | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | OS17835 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | O-0717 | ID | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.