Provider Demographics
NPI:1497735591
Name:LYONS, CLARENCE FRANKLIN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:FRANKLIN
Last Name:LYONS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:775 E TOM T HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-7040
Mailing Address - Country:US
Mailing Address - Phone:606-286-5065
Mailing Address - Fax:
Practice Address - Street 1:33 SHORT RDG
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-8313
Practice Address - Country:US
Practice Address - Phone:606-286-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008635207Q00000X
KY02947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100007590Medicaid
KY7100007590Medicaid