Provider Demographics
NPI:1437716529
Name:LYONS, JESSE TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:TYLER
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40767
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0767
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:904-391-5001
Practice Address - Street 1:4530 SAINT JOHNS AVE STE 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1852
Practice Address - Country:US
Practice Address - Phone:904-384-5222
Practice Address - Fax:904-390-7461
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME163619207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine