Provider Demographics
NPI:1023262797
Name:LYON-LOFTUS, ANTHONY E (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:LYON-LOFTUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337
Mailing Address - Country:US
Mailing Address - Phone:360-478-2366
Mailing Address - Fax:360-373-2096
Practice Address - Street 1:19917 7TH AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-1963
Practice Address - Fax:360-779-6449
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60055159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant