Provider Demographics
NPI:1548686751
Name:LYON, TRACY (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N SAN SABA STE 1210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3123
Mailing Address - Country:US
Mailing Address - Phone:210-704-4172
Mailing Address - Fax:210-704-4723
Practice Address - Street 1:315 N SAN SABA STE 1210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3123
Practice Address - Country:US
Practice Address - Phone:210-704-4172
Practice Address - Fax:210-704-4723
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX336954803Medicaid