Provider Demographics
NPI:1346226503
Name:LANYON, KENNETH MARR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARR
Last Name:LANYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:M
Other - Last Name:LANYON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:618 PRINCE VALIANT CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6499
Mailing Address - Country:US
Mailing Address - Phone:615-815-4802
Mailing Address - Fax:615-800-8610
Practice Address - Street 1:618 PRINCE VALIANT CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6499
Practice Address - Country:US
Practice Address - Phone:615-815-4802
Practice Address - Fax:615-800-8610
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 29245207L00000X
GA39618207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG01005Medicare UPIN
TN3813682Medicare ID - Type Unspecified
TN38136811Medicare PIN