Provider Demographics
NPI:1104213206
Name:LYONS, JONATHAN (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 AIRPORT GARDENS ROAD
Mailing Address - Street 2:CREDENTIALING AND PROVIDER ENROLLMENT
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-487-7503
Mailing Address - Fax:606-432-5363
Practice Address - Street 1:9879 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6026
Practice Address - Country:US
Practice Address - Phone:606-377-3427
Practice Address - Fax:606-377-3466
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2022-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY04160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100510970Medicaid