Basic Information
| Provider Information | |||||||||
| NPI: | 1215921531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2178 | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342842178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414839760 | ||||||||
| FaxNumber: | 9414869776 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 E VENICE AVE | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342923190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414839760 | ||||||||
| FaxNumber: | 9414839776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME81071 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00165071 | 01 | FL | MEDICARE RR | OTHER | 263929700 | 05 | FL | MEDICAID | 06125 | 01 | FL | BCBS | OTHER |