Provider Demographics
NPI:1215921531
Name:LYON, ANTHONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:LYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2178
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284-2178
Mailing Address - Country:US
Mailing Address - Phone:941-483-9760
Mailing Address - Fax:941-486-9776
Practice Address - Street 1:1700 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3190
Practice Address - Country:US
Practice Address - Phone:941-483-9760
Practice Address - Fax:941-483-9776
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00165071OtherMEDICARE RR
FL263929700Medicaid
FL06125OtherBCBS
FL263929700Medicaid
FLP00165071OtherMEDICARE RR