Provider Demographics
NPI:1013431188
Name:LYON, JESSE THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:LYON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4197 S LAS VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-1955
Mailing Address - Country:US
Mailing Address - Phone:480-516-1185
Mailing Address - Fax:
Practice Address - Street 1:3489 S MERCY RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0431
Practice Address - Country:US
Practice Address - Phone:480-981-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-03-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant