Basic Information
| Provider Information | |||||||||
| NPI: | 1851386908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 943 S BENEVA RD | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413628644 | ||||||||
| FaxNumber: | 9419544440 | ||||||||
| Practice Location | |||||||||
| Address1: | 943 S BENEVA RD | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413628644 | ||||||||
| FaxNumber: | 9419544440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS7077 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | OS7077 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 080158286 | 01 | FL | MEDICARE RAILROAD | OTHER | 650991971 | 01 | FL | TAX ID | OTHER | 250918100 | 05 | FL | MEDICAID | 57279 | 01 | FL | BCBS | OTHER |