Provider Demographics
NPI:1720093396
Name:PYRON, LUKE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:DOUGLAS
Last Name:PYRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3020
Mailing Address - Country:US
Mailing Address - Phone:417-359-8803
Mailing Address - Fax:417-359-8454
Practice Address - Street 1:1615 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3020
Practice Address - Country:US
Practice Address - Phone:417-359-8803
Practice Address - Fax:417-359-8454
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100848210AMedicaid
KS200362620AMedicaid
MO243419306Medicaid
MO204642102Medicaid
MO243419306Medicaid
KS200362620AMedicaid
MOMA3446262Medicare PIN
OK100848210AMedicaid