Individual
DR. MATTHEW LYSNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M5825
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003805700
—
ID
01
—
10003076
REGENCE OF ID URGENT CARE
ID
01
—
10003077
REGENCE OF IDAHO
ID
05
—
8128159
—
WA
01
—
8K552
BLUE CROSS OF ID GROUP NU
ID
01
—
HBRR0
BLUE CROSS OF IDAHO IND
ID
Enumeration date
12/22/2006
Last updated
07/09/2007
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