Provider Demographics
NPI:1922021492
Name:LYONS, SAMUEL DWIGHT (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DWIGHT
Last Name:LYONS
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 1:33 LONO AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1634
Mailing Address - Country:US
Mailing Address - Phone:808-866-5335
Mailing Address - Fax:808-866-5330
Practice Address - Street 1:33 LONO AVE STE 250
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-866-5335
Practice Address - Fax:808-866-5330
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI530243OtherUHA
HIB33874OtherHMSA - 65CP - HMSA QUEST
HI6373OtherTRICARE - CHAMPUS
HI6373OtherTRICARE - CHAMPUS
HI530243OtherUHA
HI020019038Medicare ID - Type UnspecifiedRAILROAD MEDICARE