Provider Demographics
NPI:1992996060
Name:LYON, JOSHUA DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:LYON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N BEELINE HWY # 158
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4907
Mailing Address - Country:US
Mailing Address - Phone:509-999-3556
Mailing Address - Fax:
Practice Address - Street 1:4461 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7782
Practice Address - Country:US
Practice Address - Phone:928-242-3093
Practice Address - Fax:866-728-7464
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2010-0015363A00000X
AZ3657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPA2010-0015OtherNM PA LICENSE