Provider Demographics
NPI:1174620827
Name:LYMAN, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:LYMAN
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 1:1954 FORT UNION BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6899
Mailing Address - Country:US
Mailing Address - Phone:800-594-5736
Mailing Address - Fax:
Practice Address - Street 1:1954 FORT UNION BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6899
Practice Address - Country:US
Practice Address - Phone:800-594-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357887-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT18939OtherHEALTHY U
UT589575OtherDESERET MUTUAL
UTPRA04311OtherMOLINA
UT98357887105001OtherBCBS
UTQM0000054865OtherALTIUS
UT107007099103OtherIHC
UT66103OtherPEHP
UTF73557Medicare UPIN
UTQM0000054865OtherALTIUS